ACR Appropriateness Criteria Evaluation of Nipple Discharge

This is a clinical practice guideline for women and men of all ages who are experiencing nipple discharge. The guideline discusses different imaging modalities used to identify the causes of nipple discharge, such as mammography, digital breast tomosynthesis, ultrasound (US), magnetic resonance imaging (MRI) with or without intravenous (IV) contrast, fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission mammography (FDG-PEM), Tc-99m sestamibi molecular breast imaging (MBI), and ductography. In addition, image-guided core biopsy and image-guided fine needle aspiration are discussed as options for histologic diagnosis once suspicious lesions are identified. The guideline examines the appropriateness of these techniques for five clinical situations that are based on sex, age, and whether or not discharge is physiologic or pathologic.