Surgical management of nipple discharge

Purpose: Nipple discharge is reported in 2.5-3% of women with breast carcinoma. Breast carcinoma is found in approximately 8% of surgically treated patients presenting with bloody nipple discharge (ND).

Methods: In the present study 110 women with ND as a presenting symptom were examined. The discharge was spontaneous in 76 and elicited in 11 patients.

Results: After surgical intervention benign breast disease was found in 85% of patients. Thirteen women (15%) were found to have malignancy and underwent additional surgery. Cytology of the discharge was positive or suspicious for malignancy in only seven out of 13 patients found to have in situ or invasive carcinoma.

Conclusion: Women with spontaneous, single duct ND, especially when it is darkish or bloody, should have cytological examination of the fluid and mammography according to their age or additional clinical findings. Most of them will require a microdochectomy, as the possibility of finding a carcinoma among those women is between 10-15%. However, single duct papilloma is the most common cause of bloody discharge.

Nipple discharge; Papilloma; Ductal carcinoma in situ

[1] Leis H.P., Greene F.L., Cammarata A., Hilfer S.E.: "Nipple discharge: surgical significance". South Med. J., 1988, 81, 20.

[2] Seltzer M.H.: "The significance of breast complaints as correlated with age and breast cancer". Am. Surg., 1992, 58, 413.

[3] Goodson III W.H., King E.B.: "Discharges and secretion of the nipple". In: Bland K. and Copeland III E. (eds.). The Breast, Comprehensive Management of Benign and Malignant Diseases. Volume II. Philadelphia: WB Saunders 1998, 65.

[4] Devit E.J.: "Management of nipple discharge by clinical findings". Am. J. Surg., 1985, 149, 789.

[5] Jardines L.: "Management of nipple discharge". Am. Surg., 1996, 62, 119.

[6] Funderburk W.W., Syphax B.: "Evaluation of nipple discharge in benign and malignant diseases". Cancer, 1969, 24, 1290.

[7] Kilgore AR., Fleming R., Ramos M.M.: "The incidence of cancer with nipple discharge and the risk of cancer in the presence of papillary disease of the breast". Surg. Gynecol. Obstet., 1953, 96, 649.

[8] Woods E.R., Helvie M.A., Ikeda D.M., Mandell S.H., Chapel K.L., Alder D.D.: "Solitary breast papilloma: comparison of mammographic, galactographic and pathologic findings". A.J.R., 1992, 159, 487.

[9] Papanicolaou G.N., Holmquist D.G., Bader G.M., Falk E.A.: "Exfoliative cytology of the human mammary gland and its value in the diagnosis of cancer and other diseases of the breast". Cancer, 1958, 11, 377.

[10] Leis H.P.: "Management of nipple discharge". World J. Surg., 1989, 13, 736.

[11] King E.B., Chew K.L., Petrakis N.L., Ernster V.L.: "Nipple aspirate cytology for the study of breast cancer precursors". J. Natl. Cancer Inst., 1983, 71, 1115.

[12] Ciatto S., Bravetti P., Cariaggi P.: "Significance of nipple discharge clinical patterns in the selection of cases for cytologic examination". Acta Cytol., 1986, 30, 17.

[13] Carty N.J., Mudan S.S., Ravichandran D., Royle G.T., Taylor I.: "Prospective study of outcome in women presenting with nipple discharge". Ann. R. Coll. Surg. Engl., 1994, 76, 387.

[14] Iglehart J.D.: "The Breast". In: Sabiston D.C. (ed.). Textbook of Surgery. Philadelphia: WB Saunders, 1997, 559.

[15] Gulay H., Bora S., Kilictugay S., Hamaloglu E., Goksel H.: "A. Management of nipple discharge". J. Am. Coll. Surg., 1994, 178, 471.

[16] Fung A., Rayter Z., Fisher C., King D.M., Trott P.: "Preoperative cytology and mammography in patients with single-duct nipple discharge treated by surgery". Br. J. Surg., 1990, 77, 1211.

[17] Tabar L., Dean P.B., Pentek Z.: "Galactography". Radiology, 1983, 149, 31.

[18] Bauer L.R., Eckhert H.K., Nemoto T.: "Ductal carcinoma in situassociated nipple discharge: A clinical marker for locally extensive Disease". Ann. Surg. Oncol., 1998, 5, 390.

[19] State D.: "Nipple discharge in women. Is it cause for concern?". Postgrad. Med., 1991, 89, 65.

[20] Inaji H., Yayoi E., Maeura Y., Matsuura N., Tominaga S., Koyama H. et al.: "Carcinoembryonic antigen estimation in nipple discharge as an adjunctive tool in the diagnosis of early breast cancer". Cancer , 1987, 60, 3008.

[21] Inaji H., Koyama H., Motomura K., Noguchi S., Mori Y., Kimura Y. et al.: "ErbB-2 protein levels in nipple discharge: role in diagnosis of early breast cancer". Tumour Biol., 1993, 14, 271.

[22] Motomura K., Koyama H., Noguchi S., Inaji H., Azuma C.: "Detection of c-erbB-2 gene amplification in nipple discharge by means of polymerase chain reaction". Breast Cancer Res. Treat., 1995, 33, 89.

[23] Devitt J.E.: "False alarms of breast cancer". Lancet, 1989, 8674, 1257.