Probe-Guided Microdochectomy for Bloody Nipple Discharge with Normal Breast Imaging

Abstract

Purpose: Bloody nipple discharge (BND) has been associated with breast cancer in women with normal mammograms. Surgical intervention is the only reliable tool for definitive diagnosis of the cause and treatment of BND. However, in patients with BND with normal imaging and without palpable lesions, an accurate biopsy is challenging to perform. This study evaluated a combination of methylene blue and probe-guided microdochectomy as a means of diagnosing and treating patients with BND, who also had benign or normal imaging results. Materials and Methods: From August 2006 to July 2010, 26 patients with BND and occult breast lesion which were apparent on routine imaging were studied by a single breast surgeon at Mackay Memorial Hospital. All patients in this study underwent microdochectomy under sedation and local anesthesia, assisted by intra-operative use of methylene blue injected intraductally in order to trace the affected duct and its side branches. All patients in our study received nipple aspirate fluid (NAF) and ductal lavage before proceeding to microdochectomy. Results: A total of 27 microdochectomy procedures were performed in 26 patients, with a mean age of 52 years. All the patients presented with BND, with normal or benign mammography and ultrasound findings (BIRADS 1,2) in 26 cases (100%). The histopathological results in the 27 lesions biopsied demonstrated fibrocystic change and nonspecific results in 2 cases, intraductal papilloma with ductal hyperplasia in 9 cases, dilated duct with papillomatosis in 4 cases, papilloma with atypical hyperplasia in 3 cases, intraductal carcinoma in 5 cases, and invasive carcinoma in 4 cases. Clinical signs of BND were resolved in 24 patients (96%), and no complications occurred. Patients were followed for a mean period of 2.5 years. No recurrence was found in the cancer group and no subsequent breast cancer developed in the benign group. Conclusions: Microdochectomy with a combination of probe insertion and methylene blue injection is a safe procedure with high diagnostic and therapeutic value for the management of BND.