Nipple Discharge and Pathologic Involvement of the Nipple-Areolar Complex: Reconsidering Guidelines for...

Area of Science:

• Breast oncology
• Surgical oncology
• Radiology

Background:

• Nipple discharge (ND) is a common symptom in breast cancer patients.
• The association between ND and pathologic involvement of the nipple-areolar complex (NAC) is crucial for surgical planning, particularly for nipple-sparing mastectomy (NSM).
• Current guidelines often contraindicate NSM in the presence of ND due to concerns about occult NAC involvement.

Purpose of the Study:

• To determine the rate of pathologic NAC involvement in breast cancer patients presenting with ND.
• To evaluate the utility of magnetic resonance imaging (MRI) in predicting NAC involvement.
• To inform guidelines regarding NSM in patients with ND.

Main Methods:

• Retrospective review of simple and skin-sparing mastectomy cases (January 2000 - December 2023).
• Collection of clinical data including ND, imaging findings, and NAC pathologic involvement.
• Analysis of tumor-nipple distance (≤1 cm) as a predictor of NAC involvement and MRI performance.

Main Results:

• Out of 2611 mastectomy cases, 93 (3.6%) had ND.
• 36.5% of ND cases showed pathologic NAC involvement.
• MRI demonstrated high sensitivity (88.9%) and specificity (80.0%) for predicting pathologic NAC involvement, and was a significant predictor in multivariate analysis.

Conclusions:

• Approximately two-thirds of breast cancer patients with ND but no physical exam findings of NAC involvement did not have pathologic NAC involvement.
• MRI is a valuable tool for assessing NAC involvement in patients with ND.
• Current contraindications for NSM in patients with ND may be reconsidered in carefully selected cases based on imaging and clinical assessment.