Role of Contrast Enhanced Digital Mammography in Female Patients With Pathological Nipple Discharge
Role of Contrast Enhanced Digital Mammography in Female Patients With Pathological Nipple Discharge
To evaluate the validity of contrast enhanced digital mammography in evaluation of
 pathological nipple discharge .
Nipple discharge is a relatively frequent complaint in females, being the third most common
 breast symptoms prompting medical care, after breast pain and breast palpable mass. Over 80%
 of females will have an episode of nipple discharge during their fertile life,which can be
 categorized as lactional which is milky in nature and occur during pregnancy or breast
 feeding. Physiological nipple discharge, is yellow, milky or greenish in nature, it cannot
 happen spontaneously and it can often be seen coming from multiple orifices,Some causes of
 physiological nipple discharge are hypothyroidism and medication side-effects. . Pathological
 nipple discharge is defined as a clear, serous, or bloody secretion , spontaneous,
 discharging from a single duct and unilateral. It is frequently caused by a benign lesion,
 such as intraductal papilloma (35-56%) or ductal ectasia (6-59%), but an underlying
 malignancy can be present in a percentage of cases reported to be variable from 5 to 33%.

 Majority of nipple discharge cases are more frequently due to benign conditions, so less
 operative ,nonsurgical methods can be applied to limit the need for surgical intervention ,
 the woman that presents with nipple discharge should be managed as follow , ultrasound which
 is always performed in cases with nipple discharge for detection of ductal carcinoma in situ
 or invasive carcinoma , the sensitivity and specificity of ultrasound were 65% and 75% to
 85%respectively ,mammography which plays an important role in diagnosis of breast diseases
 however it has low (20-25%)sensitivity in cases with nipple discharge as the associated
 lesions are usually retro areolar ,small, intraductal and non calcified so negative
 mammography do not exclude the possibility of underlying disease , ductography,which has long
 been considered the gold standard for evaluation of nipple discharge but it has low
 sensitivity , MRI has high sensitivity in evaluation of nipple discharge up to 88% to 95%,
 and its negative predictive value is (90%) , demonstrate not only ductal lesions but also
 lesions in adjacent parenchyma and it is superior in assessment of location and extent of a
 lesion.

 Recently, contrast enhanced digital mammography has shown a very high sensitivity and
 specificity in diagnosis of breast lesions, it was approved by the U.S. Food and Drug
 Administration in 2011. The utility of CEM in the diagnostic setting for evaluation of breast
 lesion is 100% sensitivity, 87.7% specificity, 76.2%, positive predictive, 100%negative
 predictive .CEM has been found to result in more accurate tumor size estimation . In the
 evaluation of suspicious micro calcifications, the negative predictive value of CEM has been
 reported to be up to 93% . The literature also suggests that the improved performance of CEM
 relative to that of mammography is greater in women with dense breast tissue as compared with
 nondense breast tissue, with fewer false-negative cases . Additionally CEM can evaluate
 response to neoadjuvant chemotherapy and assessment of disease recurrence and also in
 screening of high risk women .
Inclusion Criteria:

 1_in diagnosis of female patients with pathological nipple discharge

 Exclusion Criteria:

 -  1. Patients with renal failure or with raised renal chemistry 2-patients who are
 allergic to contrast 2. Pregnant women