Predicting Patients Found to Have Malignancy at Nipple Duct Surgery

Area of Science:

• Surgical Pathology
• Oncology
• Radiology

Background:

• Unexpected breast cancer diagnoses post-total duct excision cause patient distress.
• Pre-operative diagnosis of malignancy remains challenging despite advances in imaging and symptom analysis.
• Identifying features predicting malignancy is crucial for surgical planning.

Purpose of the Study:

• To review pathological findings of total duct excision and microdochectomy.
• To correlate pre-operative symptoms and imaging with pathological outcomes.
• To identify features associated with an increased likelihood of malignant disease.

Main Methods:

• Retrospective data collection from a single center (2011-2017).
• Inclusion of patients who underwent total duct excision surgery.
• Correlation of pre-operative demographics, symptoms, and imaging findings with final pathology.

Main Results:

• Out of 211 patients, 7.1% had malignancy (ductal carcinoma in situ), 10% had "risk" lesions, and 82.9% had benign pathology.
• 40% of malignant cases had normal imaging (M1, U1).
• Bloody discharge was associated with malignancy in 12% of cases, while non-bloody discharge was associated with malignancy in 5.3% of cases.

Conclusions:

• Neither imaging findings nor presenting symptoms reliably correlate with the likelihood of malignancy.
• Total duct excision is an essential diagnostic and therapeutic procedure for breast conditions.
• Despite advances, pre-operative diagnostic accuracy for malignancy in this context remains limited.