Nipple discharge: surgical significance.

Area of Science:

• Breast Surgery
• Surgical Oncology
• Pathology

Background:

• Nipple discharge is a frequent breast complaint, second only to breast lumps.
• Significant nipple discharge is defined as true, spontaneous, persistent, and nonlactational.
• Various types of nipple discharge exist, including milky, purulent, watery, serous, serosanguineous, and sanguineous.

Purpose of the Study:

• To evaluate the clinical significance of different types of nipple discharge.
• To determine the incidence of cancer and precancerous mastopathy associated with surgically significant nipple discharge.
• To outline management strategies for various nipple discharge presentations.

Main Methods:

• Retrospective analysis of 7,588 patients undergoing breast surgery.
• Detailed review of 503 patients operated on for significant nipple discharge.
• Correlation of discharge characteristics with histopathological findings, including cancer and precancerous mastopathy.

Main Results:

• Among 503 surgically treated patients, 13.3% had cancer and 7.2% had precancerous mastopathy.
• Cancer was detected in 11.9% of cases without a palpable mass and 16.4% with negative cytology.
• The incidence of associated cancers increased with serous, serosanguineous, sanguineous, or watery discharge, and with patient age over 50.

Conclusions:

• Surgically significant nipple discharges warrant thorough investigation due to their association with malignancy.
• Central duct excision is recommended for surgically significant discharges, except in specific patient groups.
• Early diagnosis and appropriate management are crucial for favorable outcomes in patients with concerning nipple discharge.