title: [Management of breast nipple discharge: Recommendations].
abstract: OBJECTIVE
  To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations.
  
  
  METHODS
  Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases.
  
  
  RESULTS
  Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C).
authors.affiliation: Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France. Electronic address: l.ouldamer@chu-tours.fr.
authors.forename: L
authors.initials: L
authors.lastname: Ouldamer
authors.affiliation: Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
authors.forename: I
authors.initials: I
authors.lastname: Kellal
authors.affiliation: CESP Inserm U1018, service de gynécologie obstétrique, CHU d'Angers, 49000 Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Legendre
authors.affiliation: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP, 15, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ngô
authors.affiliation: Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Chopier
authors.affiliation: Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France.
authors.forename: G
authors.initials: G
authors.lastname: Body
mesh_terms: D001941:Breast Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D009558:Nipples / Q000000981:diagnostic imaging / Q000473:pathology*; D017410:Practice Guidelines as Topic; D011859:Radiography; D014463:Ultrasonography
keywords: Biopsie; Biopsy; Breast cancer; Cancer du sein; IRM; MRI; Nipple discharge; Pyramidectomie; Pyramidectomy; Écoulement mamelonnaire