What types of nipple discharge are considered suspicious and warrant additional imaging evaluation

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What types of nipple discharge are considered suspicious and warrant additional imaging evaluation? What imaging workup is recommended for suspicious nipple discharge?

Nipple discharge that is spontaneous, bloody, clear, or serosanguineous is considered suspicious. The first step in the evaluation should be mammography. The mammogram results may be normal or show a finding. At our institution, we also perform US to look for any suspicious lesions that may be causing the discharge. Typically, we look in the subareolar and periareolar regions.

If the mammogram and US are normal, the next step may be a galactogram. The involved ductal orifice is cannulated with a thin catheter. A small amount of contrast material, typically less than 5 cc, is injected into the ductal system until resistance is felt. A mammogram is then obtained to look for filling defects that may be the cause of the discharge. If there is a filling defect, the defect may be due to various causes, such as debris, a papilloma, or a malignancy.

MRI may also have a role in the evaluation of nipple discharge. Ultimately, if there is clinically suspicious discharge with no clear explanation, surgical duct exploration may be performed.

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