Which imaging modality is NOT useful in evaluating nipple discharge?

Which imaging modality is NOT useful in evaluating nipple discharge?

• A. Mammography
• B. Ultrasound
• C. Ductography
• D. MRI

Answer: (D)

Evaluating nipple discharge starts with targeted breast imaging to identify ductal or underlying parenchymal pathology while avoiding unnecessary tests. Mammography is useful, especially in older patients, because it can reveal masses or calcifications associated with discharge. Ultrasound complements this in younger women or when a palpable or ductal lesion needs characterization, helping to detect dilated ducts or intraductal masses. Ductography (galactography) is the specific test for persistent unilateral discharge from a single duct; it directly visualizes the ductal system and can reveal intraductal lesions like papillomas. MRI, although very sensitive, is not routinely useful for this issue due to cost, limited specificity, and a high rate of incidental findings that don’t change management; it’s generally reserved for nondiagnostic cases or when occult cancer is strongly suspected after initial imaging.

Evaluating nipple discharge starts with targeted breast imaging to identify ductal or underlying parenchymal pathology while avoiding unnecessary tests. Mammography is useful, especially in older patients, because it can reveal masses or calcifications associated with discharge. Ultrasound complements this in younger women or when a palpable or ductal lesion needs characterization, helping to detect dilated ducts or intraductal masses. Ductography (galactography) is the specific test for persistent unilateral discharge from a single duct; it directly visualizes the ductal system and can reveal intraductal lesions like papillomas. MRI, although very sensitive, is not routinely useful for this issue due to cost, limited specificity, and a high rate of incidental findings that don’t change management; it’s generally reserved for nondiagnostic cases or when occult cancer is strongly suspected after initial imaging.