Management of nipple discharge.

Area of Science:

• Breast Surgery
• Surgical Oncology
• Diagnostic Imaging

Background:

• Nipple discharge is a presenting symptom in 7.4% of breast operations.
• True, spontaneous, persistent, and nonlactational discharges are clinically significant.
• Seven types of nipple discharge exist, with four being surgically significant.

Purpose of the Study:

• To analyze the significance of nipple discharge as a presenting symptom in breast surgery.
• To determine the etiologies of surgically significant nipple discharges.
• To evaluate diagnostic accuracy and treatment outcomes for nipple discharge.

Main Methods:

• Retrospective analysis of 8,703 breast operations.
• Classification of nipple discharge types and correlation with etiology.
• Review of mammography, galactography, and cytology results.
• Assessment of treatment modalities and outcomes.

Main Results:

• Surgically significant discharges (watery, yellow, pink, bloody) were associated with benign conditions (papillomata, fibrocystic changes) in the majority of operated patients.
• Malignancy was diagnosed in 14.3% of surgically significant discharge cases, with a 9.5% false-negative mammography rate and 17.8% false-negative cytology rate.
• Factors increasing cancer likelihood include discharge type, presence of a lump, unilateral single-duct discharge, positive imaging/cytology, and age over 50.

Conclusions:

• Nipple discharge, particularly when surgically significant, necessitates thorough investigation due to potential underlying malignancy.
• Central duct excision is an effective treatment for surgically significant discharges, offering good cosmetic results and eliminating recurrence risk.
• Early and accurate diagnosis is crucial, considering the limitations of imaging and cytology in detecting malignancy associated with nipple discharge.