The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients.

Francesca Muscarà,Isabella Castellano,Luigia Macrì,Elena Vissio,Francesca Montarolo,Ivana Sarotto,Paola Cassoni,Caterina Marchiò,Carla Pecchioni,Janina Kulka,Riccardo Arisio,Davide Balmativola,Jasna Metovic,Laura Annaratone,Nelson Rangel,Anna Sapino

doi:10.1371/journal.pone.0182073

Abstract

BackgroundThe role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy.MethodsWe retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears.ResultsThirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, χ251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, χ211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues.ConclusionsMalignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases.

Highlights

Nipple discharge (ND) accounts for approximately 5% of breast-related symptoms [1] and is the third most common reason women seek medical attention, following breast lumps and breast pain [2]
The majority of the patients with malignant nipple discharge cytology (NDc) were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P
Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P

Summary

Introduction

Nipple discharge (ND) accounts for approximately 5% of breast-related symptoms [1] and is the third most common reason women seek medical attention, following breast lumps and breast pain [2]. The role of the cytological results of ND samples in the planning of surgical approaches for patients remains unsettled. Some authors consider it together with clinical and radiological assessment as a diagnostic evaluation of the risk of underlying carcinoma [8], others recommend to exclude ND cytology (NDc) from the diagnostic algorithms of breast diseases to avoid confusion in patient surgical management [9], whereas others include it but do not give recommendations in case of malignant NDc results [10]. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy

Objectives

Methods

Results

Conclusion