Posted on: Jul 29, 2017 04:43AM
Posted on: Jul 29, 2017 04:43AM
from the American College of Radiology
"Nipple discharge is a common complaint that leads patients to breast imaging evaluation. At least 80% of women will experience at least 1 episode of nipple discharge during their reproductive years. Nipple discharge is the third most common breast complaint after breast pain and breast mass, with a prevalence of 4.8% to 7.4%, and accounts for 5% of all breast symptoms. It is categorized as physiologic or pathologic.
Pathologic nipple discharge tends to be unilateral, from a single duct orifice, spontaneous, and serous or bloodstained. Nipple discharge that exhibits any one of these features may be considered pathologic.
Physiologic nipple discharge tends to be bilateral, from multiple duct orifices, and white, green, or yellow in color. In a study by Goskel et al, nonspontaneous nipple discharge, which was frequently colored or milky, was differentiated from spontaneous nipple discharge, which was considered pathologic. In this study, none of the patients with nonspontaneous nipple discharge developed cancer on follow-up examination. In another study by Bahl et al, no in situ or invasive cancers were found in patients whose nipple discharge did not exhibit any of the pathologic features. If patient history and physical examinations demonstrate physiologic nipple discharge and routine screening mammography is up to date, no radiologic investigation is needed.
Jan 10, 2020 04:53AM djmammo wrote:
When I use the word "abnormality" in an x-ray report I am referring to something I saw that should not be there. It is a neutral term not meaning benign or malignant but it is something that will need a work up to see which of those things it might be.
Going back to the wording of your ductogram report: If I open the pantry and look for a box of crackers but I am unable to move things and look behind them, the best I can say is "no crackers are seen" or "there is no evidence of crackers" but at that point I cannot definitively say "there are no crackers in the pantry".
Jan 10, 2020 05:53PM - edited Jan 10, 2020 06:06PM by hazelb712
The result for MRI just came back...
MRI BREAST BILAT WO/W CONTRAST W/CAD
CLINICAL INDICATION: 30-year-old woman presenting for evaluation of intermittent right-sided bloody nipple discharge. No family
history of breast cancer.
COMPARISON: Reports from ductogram dated 10/30/2019, mammogram dated 10/16/2019, and ultrasound dated 10/9/2019. Images is not available for comparison at this time.
TECHNICAL FACTORS: Utilizing Siemens SKYRA 3T magnet, axial T1, axial T2 STIR, axial gradient echo T1 with fat saturation pre and
post contrast, axial VIEWS, sagittal T2 with fat saturation, axial
diffusion were obtained. Subtraction images, 3D reconstruction
and analysis was performed on independent CAD workstation by DynaCAD.
IMAGING MEDICATIONS: gadobutrol (GADAVIST) 7.5 mmol/7.5 mL (1 mmol/mL) injection 6 mL
Overall breast composition: There is heterogenously dense fibroglandular tissue. The background parenchymal enhancement is mild and symmetric.
Right Breast: No abnormal areas of enhancement or other MR features of malignancy are identified. No definite MRI correlate to the reported symptom of intermittent bloody right nipple discharge is identified.
Left Breast: No abnormal areas of enhancement or other MRI features of malignancy are identified.
Other: The axillae and visualized chest are unremarkable.
Right Breast: No MRI features of malignancy. No definite MRI correlate to the reported symptoms of intermittent bloody right nipple discharge is identified, therefore management should be based on findings at clinical breast exam.
Left Breast: No MRI features of malignancy.
BI-RADS: Category 1 normal examination. Recommend clinical management of intermittent bloody right nipple discharge.
COMMENT: Please note that breast MRI may not be sensitive to low grade and some intermediate grade DCIS as well as low grade tumors such as mucinous and tubular carcinomas. This examination does not evaluate the high axillary nor supraclavicular lymph nodes.
ASSESSMENT: BIRADS 1: Negative
RECOMMENDATION: Bilateral/Clinical Management Recommendation WITHOUT Due Date
However, it says that “ Please note that breast MRI may not be sensitive to low grade and some intermediate grade DCIS as well as low grade tumors such as mucinous and tubular carcinomas. This examination does not evaluate the high axillary nor supraclavicular lymph nodes"
So no one really knew what happened last September for the first time / spontaneous bleeding, if we said the other three times were because I squeezed so hard and ruptured the blood vessel... the breast surgeon told me to have a more healthier life style, lose some weights, and go back to see him immediately if I find bloody stain on my bra next time... also he said during his 20 + years of experiences, he saw a lot of situations like this, he said it was not uncommon. he also said it might be physiological(?)...So should I be assured and came back to follow up every 3 months as he said? I am surprised that my Mammo is BIRADS 3 but MRI is BIRADS 1.
Thanks a lot for the help and for this forum. I already started making monthly recurring donations to Breast Cancer Research Foundation. Dollar amount is really small as I don't earn a lot... but I hope I can help with the research and with more people.
Jan 11, 2020 03:40AM - edited Jan 11, 2020 06:22AM by djmammo
I am surprised that my Mammo is BIRADS 3 but MRI is BIRADS 1
The Birads number is assigned to the individual study not all your studies together as a whole.
For diagnostic purposes, it is important that any bloody discharge you have is spontaneous and not provoked. Waiting until you see it as a spot in your clothing is good advice.
As far as the MRI results are concerned many papillomas measure well under 1cm and may not easily seen on MRI.
Jan 18, 2020 08:43PM - edited Jan 18, 2020 08:55PM by AnnaBNana712
Hi, DJmammo et al... I had some bloody nipple discharge after I squeezed my nipple a few months ago, and the mammogram, ultrasound and MRI all came back negative (benign). I also had an MRI because my prolactin was raised and I have a prolactinoma, but that, too, came back fine. I was told to come back in 6 months (March) for follow up and another routine mammo. Around New Year's, my breasts were, again, sore, and 'full.' I am 67, not nursing. I am an endometrial cancer survivor of over 5 years, and I am thinking that perhaps this newest incident is just 'more of the same.' and not cancer..
So this time, I squeezed it - very gently, and only '2 squeezes.' Again, blood came out. I called the breast surgeon I'd seen before, and asked if I really needed to come in, as my tests were all benign, or if it could wait until my March mammo. The nurse called me back and said I needed to come in, so I made an appointment for 1.27. This week, I went to my primary care doc for general follow-up, and she saw that I had an appointment with the breast surgeon.
She felt my breast, and found no lump (unlike last time), and she was going to try to express the fluid. I was afraid it would hurt, so I did it for her - very gently, only once. A fat drop of dark red blood came out. It looked sort of 'brownish-red' on the paper towel she gave me, and it wasn't thick or sticky. She was clearly uncomfortable seeing the blood. I asked if it could be a papilloma. She told me she didn't know, but she was glad they moved my appointment up from March, because 'that's not normal.' She had turned to her computer when she said that. She said the surgeon would see her notes.
This prompted more reading online (yeah, I know...but I do try to stick with good sites), and most of the articles about 'nipple discharge' and 'papilloma' said that, 'if you have to express the fluid for it to come out, don't worry about it.' Then I saw a few articles that left the door open for expressed discharge to also be cancer. I had made up my mind to ignore it, as it was 'benign' on prior tests, but now I'm not so sure. I also just read the topic above, and your reply, and you told the writer that it was important for diagnosis that the discharge was spontaneous. My question simply is, "Can expressed blood from one breast, in the center, be a sign of breast cancer, or is it most likely benign? Just trying to get as much info as i can before going for my appointment. Thanks.
Jan 18, 2020 10:08PM Asuncions wrote:
I'm 39. About two weeks noticed a clear water discharge from one of my breasts. It only happens if I squeeze the breast. But I can see that it only comes out of one duct. Went to my general dr. She did a self check and didnt notice any lumps. She ordered blood work and everything came back normal. She ordered a mammogram and an ultrasound. Getting them them next week. But I'm worried sick. Thinking the worst
Jan 19, 2020 05:25AM djmammo wrote:
A papilloma may not be visible on mammo or US or MRI as they may only measure a few millimeters. The gold standard for seeing them is a ductogram. Most are benign. Some are found to have some atypical or other suspicious cells in them under the microscope, but all of them are removed regardless. I have yet to see an outright intraductal cancer but thats just my experience.
Jan 19, 2020 10:39PM AnnaBNana712 wrote:
Thanks. I am thinking it would be benign, but as I was seen initially by a breast surgeon, at a hospital cancer center, on referral from my PCP,, was fearing they might want to do more stuff, like a ductogram. Just hoping I don't need for them to do a biopsy or surgery. Thanks for your reply.
Jan 24, 2020 04:20PM Twinkle01 wrote:
I have had some tenderness and areola spots for over a year to my right breast, it also appears more fuller recently. A few nights ago I noticed a dark brown discharge coming from one specific spot on my right nipple. It has continued since.
I went to my GP today and have been referred to Breast Clinic. I’m 36 and my grandmother had a pre cancerous breast mass removed 10 years ago.
I’m so scared, I haven’t noticed any masses though. So glad I found this forum