Abstract
Introduction. Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic. Benign and malignant causes of spontaneous nipple discharge continue to be difficult to distinguish. We analyse our experience of duct excisions for spontaneous nipple discharge to try to identify features that raise suspicion of breast cancer and to identify features indicative of benign disease that would be suitable for nonoperative management. Methods. Details of one hundred and ninety-four patients who underwent duct excision for spontaneous nipple discharge between 1995 and 2005 were analysed. Results. Malignant disease was identified in 11 (5.7%) patients, 4 invasive and 7 insitu, which was 10.2% of those presenting with bloodstained discharge. All patients with malignant disease had bloodstained discharge. Discharge due to malignant disease was more likely to be bloodstained than that due to benign causes (Fisher's exact test, 2-tailed P value = 0.00134). Conclusion. Our findings do not support a policy of conservative management of spontaneous bloodstained nipple discharge. Cases of demonstrable spontaneous bloodstained nipple discharge should undergo duct excision to prevent malignant lesions being missed.
Highlights
Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic
The aim of this study was to analyse our experience of duct excision for nipple discharge, in an attempt to identify features that raise the suspicion of breast cancer, and to identify features indicative of benign disease where duct excision can be avoided
One hundred and ninety-four duct excisions were performed for spontaneous nipple discharge alone, 135 total duct excision, and 59 microdochectomies
Summary
Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic. We analyse our experience of duct excisions for spontaneous nipple discharge to try to identify features that raise suspicion of breast cancer and to identify features indicative of benign disease that would be suitable for nonoperative management. Malignant disease was identified in 11 (5.7%) patients, 4 invasive and 7 insitu, which was 10.2% of those presenting with bloodstained discharge. All patients with malignant disease had bloodstained discharge. Discharge due to malignant disease was more likely to be bloodstained than that due to benign causes (Fisher’s exact test, 2-tailed P value = 0.00134). Cases of demonstrable spontaneous bloodstained nipple discharge should undergo duct excision to prevent malignant lesions being missed. 55% of patients presenting with nipple discharge have an associated mass, 19% of which are malignant [3]. Where the nature of the discharge is suspicious, duct excision is required to exclude breast cancer
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