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Nipple discharge in a screening programme: imaging findings with pathological correlation.

James Han-Su Seow1, Cecily Metcalf, Elizabeth Wylie

  • 1Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia. jhs_seow@hotmail.com

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Nipple discharge in breast cancer screening is rarely linked to serious disease. Most cases involve benign conditions like mammary duct ectasia or intraduct papillomas, with cancer being uncommon.

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Area of Science:

  • Radiology
  • Pathology
  • Oncology

Background:

  • BreastScreen Australia offers mammographic screening to women aged 50-69.
  • Nipple discharge is an uncommon symptom in screening mammography attendees.
  • Significant underlying breast disease is infrequently associated with nipple discharge.

Purpose of the Study:

  • To evaluate the association between nipple discharge and significant breast disease in a screening population.
  • To correlate radiological findings with pathological diagnoses for women presenting with nipple discharge.
  • To present cases of benign and malignant breast conditions causing nipple discharge.

Main Methods:

  • Retrospective review of 76 women with nipple discharge recalled to BreastScreen Western Australia (2004-2008).
  • Analysis of pathology investigations including nipple discharge smears, fine needle aspirations, core biopsies, and surgical biopsies.
  • Correlation of imaging findings with histopathological results.

Main Results:

  • 11 intraduct papillomas and 1 invasive ductal carcinoma with ductal carcinoma in situ were diagnosed.
  • 14 patients showed imaging findings consistent with benign mammary duct ectasia.
  • The majority of nipple discharge cases were associated with benign breast conditions.

Conclusions:

  • Nipple discharge in breast screening is uncommon and typically not indicative of significant malignancy.
  • Benign conditions such as mammary duct ectasia and intraduct papillomas are the most frequent causes.
  • Radiological and pathological correlation is essential for accurate diagnosis of nipple discharge causes.