Clinical and Imaging Characteristics in the Diagnosis and Surgical Management of Nipple Discharge Without Clinically Palpable Masses: A Retrospective Cohort Study.

BACKGROUND

The study aimed to investigate clinical and imaging features in the diagnosis and surgical management of nipple discharge without palpable masses.

METHODS

Consecutive patients undergoing surgery for nipple discharge without palpable masses (January 2014-December 2024) were retrospectively enrolled. Clinical, imaging (ultrasound, mammography, MRI), surgical, and pathological data were analyzed. Diagnostic performance of imaging modalities for intraductal lesions/malignancy and their role in incision selection were evaluated. Multivariate regression identified independent risk factors.

RESULTS

Among 664 patients (676 breasts), 512 were pathology-positive cases. Older age (> 50 years), postmenopausal status, bloody/yellow discharge, and single-duct involvement correlated with intraductal-lesions/malignancy (p < 0.05). MRI demonstrated superior sensitivity for detecting intraductal-lesions (81.25%) and cancer (87.32%) versus ultrasound (64.51%/74.26%) and mammography (26.46%/50.39%), with 84.62% concordance in surgical localization. Bloody/yellow discharge, positive ultrasound, and MRI independently predicted intraductal-lesions (p < 0.05).

CONCLUSION

MRI offers optimal diagnostic sensitivity and precise spatial guidance for surgery. Bloody/yellow discharge, along with positive ultrasound and MRI findings, informs risk stratification and surgical intervention.