Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery



+44 (0)20 3312 1947d.leff




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus






BibTex format

author = {Hadjiminas, D and Leff, D and Cunningham, D and Thiruchelvam, P and Hogben, K and Al, Mufti R and Vella, J and Zacharioudakis, K and Kontoulis, T and Ramakrishnan, R and Zhao, J},
doi = {10.1007/s10549-019-05321-w},
journal = {Breast Cancer Research and Treatment},
pages = {115--120},
title = {Can we see what is invisible? The role of MRI in the evaluation and management of patients with pathological nipple discharge},
url = {},
volume = {178},
year = {2019}

RIS format (EndNote, RefMan)

AB - Introduction: The aim of this study was to determine the ability of MRI to identify and assess the extent of disease in patients with pathological nipple discharge (PND) with an occult malignancy not evident on standard preoperative evaluation with mammography and ultrasound.Methods: Patients presenting to the breast unit of Imperial College Healthcare NHS Trust between December 2009 and December 2018 with PND and normal imaging were enrolled in the study. Pre-operative bilateral breast MRI was performed in all patients as part of our protocol and all patients were offered diagnostic microdochectomy. Results: A total of 82 patients fulfilled our selection criteria and were enrolled in our study. The presence of an intraductal papilloma (IDP) was identified as the cause of PND in 39 patients (48%), 15 patients had duct ectasia (DE-18%) and 4 patients had both an IDP and DE. Other benign causes were identified in 10 patients (12%). Despite normal mammography and ultrasound a malignancy was identified in 14 patients (17%). Eleven patients had DCIS (13.4%) , two had invasive lobular carcinoma and one patient had an invasive ductal carcinoma. The sensitivity of MRI in detecting an occult malignancy was 85.71% and the specificity was 98.53 %. The positive predictive value was 92.31% and the negative predictive value was 97.1%.Conclusions: Although a negative MRI does not exclude the presence of an occult malignancy the high sensitivity and specificity of this diagnostic modality can guide the surgeon and alter the management of patients with PND.
AU - Hadjiminas,D
AU - Leff,D
AU - Cunningham,D
AU - Thiruchelvam,P
AU - Hogben,K
AU - Al,Mufti R
AU - Vella,J
AU - Zacharioudakis,K
AU - Kontoulis,T
AU - Ramakrishnan,R
AU - Zhao,J
DO - 10.1007/s10549-019-05321-w
EP - 120
PY - 2019///
SN - 0167-6806
SP - 115
TI - Can we see what is invisible? The role of MRI in the evaluation and management of patients with pathological nipple discharge
T2 - Breast Cancer Research and Treatment
UR -
UR -
VL - 178
ER -