Objective: To evaluate the role of invasive imaging in the identification and pre-surgical localization of endoductal breast lesions. Methods: We retrospectively evaluated cytological outcomes, non-invasive/invasive breast imaging obtained between January 2016 and December 2019 in women with pathological nipple discharge (PND). We analysed sensitivity, specificity, positive predictive value and negative predictive value. We also evaluated the advantages of a pre-surgical radiological study using an endoductal contrast medium (with 3D-technique, in young women with dense breasts). Results: A total of 286 women with PND underwent cytological examination, mammography and/or breast ultrasound. When the cytological outcome was reported as "negative" (66.78%) in agreement with negative noninvasive imaging, patients were sent to follow up. Patients with cytological outcomes defined as "bloody with papillary clusters" (29.37%) "bloody not associated to cytological modifications" (2.44%), or "atypical/suspected" for malignant (1.39%) underwent an invasive procedure. Sensitivity, specificity, positive predictive value and negative predictive value were, respectively: 92.63%, 100%, 100% and 96.46% for cytological examination; 64.28%, 96.95%, 60% and 97.44% for mammography; 41.11%, 97.44%, 88.09% and 78.27% for ultrasound; 93.68%, 100%, 100% and 96.95% for invasive procedures. Post-surgical histological outcomes confirmed the diagnosis. Conclusion: In absence of a standard diagnostic algorithm, we recommend invasive procedures to identify intraductal breast lesions and for preoperative planning. Digital imaging and new technologies such as 3D-tomosynthesis lead to a renaissance of breast inva-

Objective: To compare mammographic features before and after accelerated hypofractionated adjuvant wholebreast radiotherapy (AWB-RT) and to evaluate possible appearance of modifications. Methods: A retrospective review of 177 females before and after an AWB-RT treatment (follow-up ranging from 5 to 9 years) was performed by four radiologists focused in breast imaging who independently evaluated diffuse mammographic density patterns and reported on possible onset of focal alterations; modifications in density and fibrosis with parenchymal distortion were deemed as indicators of AWB-RT treatment impact in breast imaging. Results: Prevalent mammographic density (D) patterns in the 177 females evaluated were according to the American College of Radiology-Breast Imaging Reporting and Data System (ACR-BIRADS): D1, fibroadipose density (score percentage from 55.9% to 43.5%); and D2, scattered fibroglandular density (from 42.9% to 32.7%). No change in diffuse mammographic density and no significant difference in mammographic breast parenchymal structure were observed. "No change" was reported with score percentage from 87% to 79.6%. Appearance of fibrosis with parenchymal distortion was reported by all radiologists in only two cases (1.1%, p 5 0.3); dystrophic calcification was identified with percentage score from 2.2% to 3.3% (small type) and from 9.6% to 12.9% (coarse type). Conclusion: No statistically significant changes in followup mammographies 5-9 years after AWB-RT were detected, justifying large-scale selection of AWB-RT treatment with no risk of altering radiological breast parameters of common use in tumour recurrence detection. Advances in knowledge: The hypofractionated radiotherapy (AWB-RT treatment) is a new proven, safe and effective modality in post-operative patients with early breast cancer with excellent local control and survival. In our study, the absence of changes in mammographic density patterns and in breast imaging before and after AWB-RT treatment (up to 5-9 years after radiotherapy) justifies large-scale use of AWB-RT treatment without hindrance in tumour recurrence diagnosis.