215. Colour inking of breast wide local excision specimens in theatre: Time economy for the surgeon looking to improve departmental pathology diagnostics

Abstract

Background: Nipple discharge has a known association with breast cancer, determing which cases to identify as being at high risk is a complex task for the clinician. The current policy at West Herfordshire hospital NHS Trust is to offer microdochectomy to all women who present with unilateral single duct nipple discharge, dominant duct discharge, or persistent duct discharge. The aim of this study was to determine if on basis of the pattern of nipple discharge, patients could be subselected for microdochectomies, and to create a base line to allow future subselection of patients for surveillance only Methods: All patient with single duct unilateral spontaneous nipple discharge, who underwent microdochectomy, were assessed. Demographics, clinical presentation, radiological assessment, cytology, core biopsy. This group of patients was analysed and correlated with their final histological assessment. Results: 122 patients were analysed in this study. 7 ( 5.74%) were diagnosed with carcinomas. 4 patients had ductal carcinoma in situ, three patients had dutcal carcinoma in situ and invasive ductal carcinoma, of these two patients had blood stained nipple discharge. Two other patients had papillary carcinomas, one patient of these two had blood stained nipple discharge. 47 out of 122 patient presented with history of blood statined discharge, 30 were negative for cytology, two patients had (ductal carcinoma in situ with Invasive ductal carcinoma and papillary ca) at final histololgy. 17 of the 47 showed cellular cytology, and one patient had intermediate grade DCIS confirmed on final histology, whereas in the remaining sixteen patients histological features of papillomas, duct ectasia, and benign breast disease was noted. Of the 122 patient 42 patients had mammary duct ectasia (34%), 52 patients had papillomas (42%) at final histology. Conclusions: The negative predictive value (2/30), appears in this series appears to be more valuable than, the positive predictive value (1/17) in cellular smears to predict ductal carcinoma or invasive ductal carcinoma. Cytological assessment of nipple discharge is equivocal at its best. Microdochectomy perford for nipple discharge results in a low rate of malignancy on excision and is comparable with other series. No conflict of interest.