Evaluation of nipple discharge in benign and malignant diseases

Abstract

The evaluation of nipple discharges unrelated to gestation should proceed in an orderly fashion. Our experience, based on evaluation of 257 ducts from 182 patients, suggest that location of the lesion can be assured with or without a palpable mass by using contrast mammography. Serous and bloody discharges are the most important types of secretions. Eleven of the papillary lesions and cancers presented this fluid, except 4 papillomas which had clear secretions. Nonspontaneous discharges of all types arc followed and exploration delayed until either a mass, positive Pap smear, or contrast mammogram is evident. Even though cancer is suspect in patients after the age of 40, our series shows that papillomas are the most frequent lesion encountered in the fourth and fifth decades. However, in the sixth decade, cancer comprised 50 percent of all lesions causing nipple discharge. Needless mastectomy can be avoided in patients without a palpable mass by locating and removing the duct of discharge and basing surgical treatment on die microscopic report.

Exfoliative cytology in the diagnosis of breast disease

“…Their mean age was 50 years. The surgical procedures performed were mastectomy (24), wide local excision (five), excision of breast lump (21), subareolar duct excision (20), microdochectomy (18), incision biopsy (eight) and guided biopsy (five). Of the 101 patients with a histological diagnosis, 88 had unilateral discharge and 40 had clearly identifiable single duct discharge.…”

Clinical management of nipple discharge in neonates and children

“…In adults, nipple discharge is associated with carcinoma in only 10−15% of cases 10,11 . Benign discharge is, in general, bilateral, not spon­taneous, and occurs with breast manipulation or stimulation, whereas suspicious discharge is usually unilateral, spontaneous and persistent 12 . For that reason, the management of unilateral versus bilateral discharge is different.…”

Cytology of abnormal nipple discharge: a cyto‐histological correlation

“…Nipple discharge can result from physiological or pathological disorders 1–5 . Physiological nipple discharge is usually bilateral, nonspontaneous, and is usually produced by suction or manual expression.…”

“…Spontaneous nipple discharge in the nonlactating breast is considered an abnormal discharge that needs further evaluation even in the absence of a palpable mass 1 . Abnormal nipple discharge can result from benign causes or secondary to a malignant neoplasm 1–5 . Investigation modalities include cytological examination and galactography.…”