New York University Long Island Division, Long Island, NY, USA.
NYU Winthrop Hospital, Mineola, NY, USA.
Br J Radiol. 2021 Apr 1;94(1120):20201013. doi: 10.1259/bjr.20201013. Epub 2021 Feb 5.
Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.
病理性乳头溢液（PND）通常为单侧、自发性，涉及单个乳管，外观为浆液性或血性。对于 PND 患者，当乳腺 X 线摄影和超声等常规影像学检查为阴性时，乳腺 MRI 可以作为一种额外的诊断工具。当乳腺 X 线摄影和超声等初始影像学检查为阴性时，MRI 能够在 56%-61%的病例中检测到乳头溢液的病因。在评估 PND 时使用 MRI 的优点包括能够很好地显示乳晕后乳腺，并且能够更好地评估可能在乳腺 X 线摄影和乳管造影中评估不佳的后病变。与中央乳管切除相比，它的侵袭性也较小。乳头状瘤和乳头腺瘤是良性乳腺肿块，可引起 PND，在 MRI 上能很好地显示。乳腺导管扩张症和乳腺炎、脓肿和瘘管等感染性病因也是 PND 的其他良性病因，在 MRI 上也能很好地评估。MRI 还非常适合评估 PND 的恶性病因，包括派杰病、导管癌和浸润性癌。MRI 的高阴性预测值为 87%-98.2%，有助于排除 PND 的恶性病因。
