Evaluation and management of pathological nipple discharges without using intraductal imaging methods

Background The role of duct excision surgery is not clearly defined in patients with pathological nipple discharge without other clinical and radiological abnormalities. The primary aim of this systematic review was to determine the malignancy rate in patients with pathological nipple discharge after duct excision surgery (microdochectomy/major duct excision). The secondary aims were to determine the recurrence rate of pathological nipple discharge after surgery and to assess breast cancer development after surgery. Methods MEDLINE and Embase were searched from inception to March 2023, using search terms related to ‘nipple discharge’, ‘nipple fluid’, ‘microdochectomy’, ‘duct excision’, and ‘minimally invasive surgical procedure’. Studies reporting data about women who underwent duct excision surgery for pathological nipple discharge without clinical and radiological suspicion of breast cancer, as well as reporting data on women diagnosed with breast cancer after duct excision surgery, were included. Results A total of 318 titles were identified, of which nine publications were included in the analysis. This resulted in 1108 patients with pathological nipple discharge who underwent a duct excision. The weighted mean rate of malignancy after duct excision surgery was 8.1 per cent (ranging from 2.3 to 13.5 per cent). Three studies described the recurrence rate of pathological nipple discharge (ranging from 0 to 12 per cent) and two studies reported breast cancer development in the follow-up in a total of three patients (less than 1 per cent). Conclusion The malignancy rate after duct excision surgery for pathological nipple discharge was low in patients with pathological nipple discharge without radiological and clinical abnormalities and approximately 9 of 10 patients undergo surgery for a benign cause. Improvement of the diagnostic and therapeutic workup is needed to prevent patients from undergoing (unnecessary) exploratory surgery.

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“…Çetin et al . 27 reported a recurrence rate of 0 per cent; however, the follow-up interval was not reported.…”

Section: Resultsmentioning

confidence: 95%

“…The role of surgery in the actual treatment of PND was described in just three studies that reported a recurrence rate of PND ranging from 0 to 12 per cent 27–29 . Gui et al .…”

Section: Discussionmentioning

confidence: 99%

Role of duct excision surgery in the treatment of pathological nipple discharge and detection of breast carcinoma: systematic review

et al. 2023

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“…of patients No. of samples Sensitivity Specificity PPV NPV Mammography Alcock and Layer 37 49 49 0 Bauer et al 38 12 0.5 Cabioglu et al 39 188 23 Cabioglu et al 20 146 69 0.69 0.75 0.42 0.9 Çetin and Sikar 41 111 95 0.17 0.96 Fung et al 46 840 176 0.13 0.99 Grunwald et al 67 65 58 0.38 0.92 Kalu et al 55 160 89 0.33 0.82 0.78 0.38 Morrogh et al 10 …”

Section: Resultsmentioning

confidence: 99%

“…of patients No. of samples Malignant sensitivity (relative Cn3/4/5) Malignant PPV Malignant NPV Malignant sensitivity (absolute Cn5) Alcock & Layer 37 49 49 0.33 1.00 0 Bauer et al 38 12 23 1.00 Cabioglu et al 39 188 23 0.30 1.00 0 Cabioglu et al 20 146 69 0.81 0.28 0.80 Carty et al 40 56 56 0.75 0.50 0.50 Çetin & Sikar 41 111 95 0.77 0.19 0.83 Ciatto et al 42 50181 3687 0.61 0.64 0.88 Cilotti et al 43 67 67 0.83 0.23 1.00 …”

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature

et al. 2021

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Background Nipple discharge is the third most frequent complaint of women attending rapid diagnostic breast clinics. Nipple smear cytology remains the single most used diagnostic method for investigating fluid content. This study aimed to conduct a systematic review and meta-analysis of the diagnostic accuracy of nipple discharge fluid assessment. Methods The study incorporated searches for studies interrogating the diagnostic data of nipple discharge fluid cytology compared with the histopathology gold standard. Data from studies published from 1956 to 2019 were analyzed. The analysis included 8648 cytology samples of women with a presenting complaint of nipple discharge. Both hierarchical and bivariate models for diagnostic meta-analysis were used to attain overall pooled sensitivity and specificity. Results Of 837 studies retrieved, 45 fulfilled the criteria for inclusion. The diagnostic accuracy of the meta-analysis examining nipple discharge fluid had a sensitivity of 75 % (95 % confidence interval [CI], 0.74–0.77) and a specificity of 87 % (95 % CI, 0.86–0.87) for benign breast disease. For breast cancer, it had a sensitivity of 62 % (95 % CI, 0.53–0.71) and a specificity 71 % (95 % CI, 0.57–0.81). Furthermore, patients presenting with blood-stained discharge yielded an overall malignancy rate of 58 % (95 % CI, 0.54–0.60) with a positive predictive value (PPV) of 27 % (95 % CI, 0.17–0.36). Conclusions Pooled data from studies encompassing nipple discharge fluid assessment suggest that nipple smear cytology is of limited diagnostic accuracy. The authors recommend that a tailored approach to diagnosis be required given the variable sensitivities of currently available tests.

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High-Risk Lesions

Nori

Kaur

Kornecki

et al. 2021

Atlas of Contrast-Enhanced Mammography

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Evaluation and management of pathological nipple discharges without using intraductal imaging methods

Cited by 4 publications

References 27 publications

Role of duct excision surgery in the treatment of pathological nipple discharge and detection of breast carcinoma: systematic review

Role of duct excision surgery in the treatment of pathological nipple discharge and detection of breast carcinoma: systematic review

Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature

High-Risk Lesions

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