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Nonsurgical evaluation of pathologic nipple discharge
Rache Simmons1, Tara Adamovich, Meghan Brennan
1Weill Cornell Breast Center, Department of Surgery, New York, New York, USA. rms2002@med.cornell.edu
Annals of Surgical Oncology
|March 7, 2003
Summary
Preoperative tests for nipple discharge, including mammography and cytology, are unreliable for diagnosing malignancy. Surgical biopsy is recommended for accurate diagnosis in patients with pathologic nipple discharge.
Area of Science:
- Breast surgery
- Surgical pathology
- Diagnostic imaging
Background:
- Nipple discharge is a frequent breast concern.
- Most nipple discharge cases are benign.
- Less-invasive diagnostic methods are sought to avoid surgery.
Purpose of the Study:
- To evaluate preoperative diagnostic tests for nipple discharge.
- To compare test accuracy with surgical pathology.
- To determine the predictive value of various diagnostic modalities.
Main Methods:
- 108 female patients with nipple discharge underwent duct excision.
- Preoperative mammography, Hemoccult, ductography, and cytology results were analyzed.
- Sensitivity, specificity, and predictive values were calculated against histopathology.
Main Results:
- Histopathology revealed 90 benign, 5 atypical, and 13 malignant cases.
- Mammography: Sensitivity 57.1%, Specificity 61.5%.
- Cytology: Sensitivity 11.1%, Specificity 96.3%.
- Ductography: Sensitivity 0%, Specificity 90%.
- Hemoccult: Sensitivity 50%, Specificity 0%.
Conclusions:
- Preoperative tests are poor predictors of malignant ductal pathology.
- Mammography, Hemoccult, ductography, and cytology showed limited diagnostic value.
- Surgical biopsy is essential for accurate diagnosis of pathologic nipple discharge.