After reviewing this education exhibit, the user will be familiar with: The types of nipple discharge How to evaluate and manage this common problem. Diagnosis and presentation of common underlying pathologies

Epidemiology: Nipple discharge (ND) is the third most common breast complaint after pain and mass. While most are of benign origin, ND may be the only symptom of an early stage of carcinoma. 3-8% of women will experience ND. ND is the principal symptom in 1-5% of breast cancers; and up to 12% of DCIS. 25-60% of men with pathologic ND have cancer, (usually IDC). The risk of underlying cancer increases with patient age. Physiologic or Pathologic? Evaluation of ND should start with clinical evaluation...

PATHOLOGIC CAUSES Benign papilloma are the most most common cause. 25% of bloody and 10-15 % of serous PND are due to carcinoma. Papilloma Papillomas represent 35 to 50% of PND cases. True papillary lesions have fibrovascular core. Papillomas appear as intraductal mass with or without associated calcifications on mammography and US. On MRI the mass is indistinguishable from invasive tumor as a small, round or oval, circumscribed or irregular, enhancing or occult luminal masses with or without enlarged ducts. They're associated with increased upgrade...

The primary goal of evaluation is first to differentiate physiologic from pathologic discharge. Use of imaging studies is to guide management of pathologic ND and to differentiate benign from malignant etiologies. Radiologists should be very familiar with indications and findings of the different imaging modalities available and with the role of surgical management in this patient population.

Shafik N. Wassef, MD, DABR Clinical Assistant Professor Women's Imaging,Department of Radiology College of Medicine, University of Florida in Gainesville No conflict of interest

GZ Li, et al, Breast J. 2018 M Bahl, et al, AJR 2017 N Berger, et al, AJR2017 M Bahl, et al, AJR 2015