title: Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge.
abstract: OBJECTIVE
  The purpose of this study was to assess the contribution of ultrasound to the evaluation of patients with pathologic nipple discharge.
  
  
  METHODS
  A retrospective review was conducted of the records of females who presented with nipple discharge between January 1, 2009, and December 31, 2011. Pathologic nipple discharge was defined as discharge with one or more of the following features: unilateral, clear or bloody, and spontaneous. Patients underwent bilateral mammography followed by ultrasound directed at the subareolar portion of the affected breast. Radiologic findings and pathologic results were reviewed.
  
  
  RESULTS
  Over a 3-year period, 327 females (mean age, 48 years; range, 13-88 years) presented with nipple discharge. Among these patients, 273 (83%) underwent surgical excision or clinical or radiographic follow-up at least 2 years after presentation and composed the study population. Among the 273 patients, 262 (96%) underwent mammography and 246 (90%) underwent sonography. Among 252 patients who had at least one pathologic feature of nipple discharge and underwent surgical excision or at least 2 years of follow-up, a total of 20 (8%) cases of ductal carcinoma in situ (DCIS) or invasive adenocarcinoma were diagnosed. DCIS or invasive adenocarcinoma was diagnosed in eight patients with normal sonographic findings. For the detection of DCIS and invasive adenocarcinoma, the sensitivity and specificity of ultrasound were 56% (10/18) and 75% (170/228); the sensitivity and specificity of mammography were 15% (3/20) and 98% (237/242).
  
  
  CONCLUSIONS
  For females presenting with pathologic nipple discharge, ultrasound is a useful diagnostic tool and may be worth including in the routine evaluation.
authors.affiliation: 1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
authors.forename: Manisha
authors.initials: M
authors.lastname: Bahl
authors.affiliation: 1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Baker
authors.affiliation: 2 Department of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Greenup
authors.affiliation: 1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
authors.forename: Sujata V
authors.initials: SV
authors.lastname: Ghate
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009558:Nipples / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary
keywords: breast; nipple discharge; ultrasound