Nipple discharge: the state of the art

Over 80% of females experience nipple discharge during their life. Differently from lactational (milk production) and physiological (white, green, or yellow), which are usually bilateral and involving multiple ducts, pathologic nipple discharge (PND) is a spontaneous commonly single-duct and unilateral, clear, serous, or bloody secretion. Mostly caused by intraductal papilloma(s) or ductal ectasia, in 5-33% of cases is due to an underlying malignancy. After clinical history and physical examination, mammography is the first step after 39, but its sensitivity is low (7–26%). Ultrasound shows higher sensitivity (63–100%). Nipple discharge cytology is limited by a false negative rate over 50%. Galactography is an invasive technique that may cause discomfort and pain; it can be performed only when the duct discharge is demonstrated at the time of the study, with incomplete/failed examination rate up to 15% and a difficult differentiation between malignant and benign lesions. Ductoscopy, performed under local anesthesia in outpatients, provides a direct visualization of intraductal lesions, allowing for directed excision and facilitating a targeted surgery. Its sensitivity reaches 94%; however, it is available in only few centers and most clinicians are unfamiliar with its use. PND has recently emerged as a new indication for contrast-enhanced breast MRI, showing sensitivity superior to galactography, with an overall sensitivity up to 96%, also allowing tailored surgery. Surgery no longer can be considered the standard approach to PND. We propose a state-of-the art flowchart for the management of nipple discharge, including ductoscopy and breast MRI as best options

Imaging of the Breast

Early detection of breast cancer combined with targeted therapy offers the best outcome for breast cancer patients. This volume deal with a wide range of new technical innovations for improving breast cancer detection, diagnosis and therapy. There is a special focus on improvements in mammographic image quality, image analysis, magnetic resonance imaging of the breast and molecular imaging. A chapter on targeted therapy explores the option of less radical postoperative therapy for women with early, screen-detected breast cancers

Mammographic interpretation training: what exactly do film-readers want?

Mammographic interpretation training: what exactly do film-readers want

Current Status of Breast Ultrasound

AbstractUltrasound (US) has a significant role in diagnostic breast imaging. It is most commonly used as an adjunctive test in characterizing lesions detected by other imaging modalities or by clinical examination. US is recognized as the modality of choice in the evaluation of women who are symptomatic and younger than 30 years of age, pregnant, or lactating. Combined mammography and US appear to have a role in screening high-risk populations. The use of standard Breast Imaging Reporting and Data System US lexicon is helpful in guiding the differentiation between benign and malignant sonographic signs. Biopsy is warranted when benign features are absent or for any feature consistent with malignancy, despite other benign findings. Whole breast and axillary US are useful in assessing tumour extension, multifocality, and the status of axillary lymph nodes. US is the modality of choice for guiding interventional breast procedures. The role of US as a guidance tool for nonoperative breast treatment is being investigated