title: Evaluation of Pathologic Nipple Discharge: What is the Added Diagnostic Value of MRI?
abstract: OBJECTIVE
  To determine the diagnostic value of magnetic resonance imaging (MRI) for the evaluation of patients with pathologic nipple discharge.
  
  
  METHODS
  We performed a retrospective review of women with nipple discharge who underwent breast MRI between January 1, 2004, and December 31, 2013. Radiographic findings, pathology results, and clinical notes were reviewed. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated.
  
  
  RESULTS
  Over a 10-year period, 103 women (mean age 46 years, range 25-72 years) underwent MRI for evaluation of nipple discharge. Ninety-one patients (88 %) underwent surgical excision or had clinical and/or radiographic follow-up at least 2 years after presentation and thus comprise the study population. Eleven (30 %) of 37 patients with MRIs coded as American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) 4 of 5 were diagnosed with ductal carcinoma in situ (n = 6) or invasive adenocarcinoma (n = 5). Seven (64 %) of 11 patients diagnosed with malignancy had a negative mammographic and sonographic workup. None of the patients with MRIs coded as BI-RADS 1, 2, or 3 was diagnosed with malignancy immediately after presentation or during the 2-year follow-up period. The sensitivity and specificity of MRI for the detection of malignancy were 100 % (11 of 11) and 68 % (54 of 80), respectively. The positive predictive value and negative predictive value were 37 and 100 %, respectively.
  
  
  CONCLUSIONS
  MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge when conventional imaging is negative. A negative MRI in this symptomatic population may obviate the need for duct exploration and excision.
authors.affiliation: Division of Breast Imaging, Department of Radiology, Duke University Medical Center, Durham, NC, USA. manisha.bahl@dm.duke.edu.
authors.forename: Manisha
authors.initials: M
authors.lastname: Bahl
authors.affiliation: Division of Breast Imaging, Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Baker
authors.affiliation: Division of Advanced Oncologic and GI Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Greenup
authors.affiliation: Division of Breast Imaging, Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Sujata V
authors.initials: SV
authors.lastname: Ghate
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009558:Nipples / Q000378:metabolism*; D011379:Prognosis; D012189:Retrospective Studies