Nipple Discharge Overview
HIDEInteractive Transcript
0:00
Our next symptom is nipple discharge.
0:05
And again, there's an ACR appropriateness
0:08
criteria for evaluation of nipple discharge.
0:11
So I advise you to check that out
0:13
in JACR and on the ACR website.
0:19
Nipple discharge can be physiological.
0:21
Usually, when it's physiological, it's bilateral
0:24
and coming from multiple duct orifices.
0:27
It can be white, yellow, or green.
0:30
Pathological nipple discharge is usually clear
0:33
or bloody and, um, generally unilateral coming
0:37
from a single duct opening and spontaneous.
0:43
The ACR recommends that for physiological
0:46
nipple discharge, um, the referring
0:49
provider should do a clinical evaluation,
0:51
but really no imaging is indicated.
0:54
For pathological nipple discharge,
0:56
that's the clear or bloody unilateral discharge.
0:59
If the patient's under age 30,
1:02
ultrasound is recommended first with mammography
1:04
at the radiologist's discretion.
1:06
Again, we have that intermediate age,
1:08
age 30 to 39, where ultrasound and mammogram,
1:12
as the first test, both get equal.
1:15
Ratings and then age 40 and up.
1:18
It's recommended to start with a
1:20
mammogram and then perform an ultrasound.
1:25
Our protocol for under age 30, we'll do the
1:28
ultrasound first and then age 30 and up.
1:30
We'll start with the mammogram
1:33
and then go to ultrasound.
1:34
So it's just that age 30 to 39
1:36
where we've decided for our group.
1:38
It makes more sense to start with the mammogram.
1:41
And then go to ultrasound.
1:43
Uh, we'll do full bilateral CC and MLO
1:46
views, and we perform retroareolar spot
1:49
magnification views with the nipple in
1:51
profile in both the CC and lateral projection.
1:55
Sometimes that helps us with, um,
1:57
masses right behind the nipple and
2:00
calcifications behind the nipple.
2:02
And then we do an ultrasound of the retroareolar
2:05
and periareolar breast, paying specific
2:07
attention to the, um, subareolar ducts.
2:10
And, um, trying to figure out if
2:13
there's a mass inside the duct that
2:15
may be causing the patient's discharge.
2:18
There are a few different causes of discharge.
2:20
I mean, obviously, it occurs
2:22
physiologically, but then for these, um,
2:25
pathological, uh, nipple discharge, it can
2:29
be related to intraductal papillomas.
2:31
That's a very frequent cause.
2:32
Sometimes just duct ectasia
2:35
or wide ducts can cause it.
2:37
And then malignancy, um, um, is
2:39
reported in 5 to 21 percent of cases.
2:42
So that's a pretty wide range.
2:44
But we know that the risk of
2:46
malignancy increases with age.
2:48
So it's really only about 3 percent at age 40,
2:51
but 32 percent if the patient's over age 60.
2:55
So we want to be careful about this,
2:57
especially in our older patient population.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
© 2024 Medality. All Rights Reserved.