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

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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.