Evaluation of nipple discharge in benign and malignant diseases.

Abstract

The evaluation of nipple discharges unrelated to gestation should proceed in an orderly fashion. Our experience, based on evaluation of 257 ducts from 182 patients, suggest that location of the lesion can be assured with or without a palpable mass by using contrast mammography. Serous and bloody discharges are the most important types of secretions. Eleven of the papillary lesions and cancers presented this fluid, except 4 papillomas which had clear secretions. Nonspontaneous discharges of all types arc followed and exploration delayed until either a mass, positive Pap smear, or contrast mammogram is evident. Even though cancer is suspect in patients after the age of 40, our series shows that papillomas are the most frequent lesion encountered in the fourth and fifth decades. However, in the sixth decade, cancer comprised 50 percent of all lesions causing nipple discharge. Needless mastectomy can be avoided in patients without a palpable mass by locating and removing the duct of discharge and basing surgical treatment on die microscopic report.