Abnormal Nipple Discharge Research Articles

Breast Ductography: A Hidden Diagnostic Gem for Patients with Abnormal Nipple Discharge

Breast Ductography: A Hidden Diagnostic Gem for Patients with Abnormal Nipple Discharge

Factors associated with breast disorders detected by clinical breast examination during pregnancy and six months postpartum in Ibadan, South-western Nigeria.

BackgroundBreast disorders (BD) during pregnancy and postpartum cause anxiety and reduce women’s quality of life. The study examined BD risk factors during pregnancy and six months after delivery.MethodsWomen attending antenatal clinics at 26 weeks gestation were recruited. 1248 pregnant women were followed six months postpartum. During recruitment, a validated questionnaire was used to collect participant characteristics and risk factors. Palpable lumps, inflammation, persistent pain, and abnormal nipple discharge were classified breast disorders. Statistical analysis used multiple logistic and cox regression models at p<0.05.ResultsWomen with benign breast disease were more likely to develop BD (aOR = 2.63, 95% CI = 1.50–4.88). One pregnancy increases the risk of BD more than three times (aOR=0.52, 95%CI: 0.29–0.95). History of breast trauma (aHR=3.59, 95%CI: 1.40–9.17) and 3 miscarriages vs. none (aHR=2.23, 95%CI: 1.04–4.23) were also risk factors for BD. The second quartile of physical activity was associated with a lower risk of BD (aHR=0.35, 95%CI: 0.15–0.78).ConclusionWomen with breast trauma and miscarriage are more likely to develop breast disorders during pregnancy and six months after delivery. Our findings highlight the need for additional longitudinal research to validate these findings and plans for prevention and control. Keywords: Breast disorders, pregnancy, postpartum, predictors, longitudinal study.

ULTRASOUND AS PRIME MODALITY OF CHOICE FOR EVALUATION OF BREAST LESIONS.

INTRODUCTION: The four main roles of ultrasound in Breast imaging are-primary screening, supplemental screening, diagnosis and Interventional procedures. Palpable masses, abnormal nipple discharge and mammographic abnormalities constitute the most common indication for targeted Breast Ultrasound. AIM: To study the role of Ultrasound in evaluating Breast lesions and characterising them as Benign or Malignant. MATERIAL AND METHODS:This is a Retrospective analysis conducted in Department of Radiology, MGM Medical College and Hospital, Kamothey, Navi Mumbai from February 2021 to June 2021. A total of 136 patients with signs and symptoms related to breast lesions were screened. CONCLUSION: The advent of high frequency probe, easy accessibility, cost effectiveness, reliability and relatively easy to perform makes ultrasound as the prime modality of choice for screening breast lesions.

Saudi women perception, attitude and awareness about abnormal nipple discharge

Background: Nipple discharge (ND) is known as any fluid that leaks from one or both nipples of a non-pregnant and non-breastfeeding breast. Intraductal papilloma, duct ectasia, papillomatosis, mastitis, or fibrocystic changes are the most frequent causes of abnormal benign conditions. Up to authors' knowledge; there are not enough published papers regarding perception and attitude of Saudi women about abnormal ND and its causes. The main objective of this study was to examine perception and attitude of Saudi women about abnormal ND among Saudi women in Kingdom of Saudi Arabia. Methods: A community-based cross-sectional study was conducted from September to November 2020. A pre-designed online questionnaire was distributed on social media targeting Saudi women in different age groups to be self administered. Data were compiled and analyzed using a statistical package for the social sciences. The relation between abnormal ND and sociodemographic characters was determined using the chisquare test. A p-value of less than 0.05 was considered to be statistically significant. Results: According to our results, 8.2% (n = 176) of participants reported abnormal breast secretions other than during pregnancy or breastfeeding. Among 30.7% (n = 54) of cases, the secretions were accompanied by redness, 41.5% reported breast pain, 48.8% had small pits or wrinkles in the skin, 36.4% suffered from nipple retraction, 35.2% reported itchy sores or a rash on the nipple, in 32.4% of cases the secretions accompanied with a change in the size or shape of the breasts, and 25.6% observed that secretions were accompanied with a change in the internal composition of the breast or the appearance of an unknown mass. Conclusion: Abnormal ND was relatively prevalent among Saudi women. There was a significant relationship between social status, smoking, menstrual cycle regularity, having children, and late for childbearing.

Retrospective statistical analysis on the diagnostic value of ductography based on lesion pathology in patients presenting with nipple discharge.

To compare sensitivities and specificities of ductography to noninvasive imaging studies in determining the cause of nipple discharge and assess the value of ductography on the basis of pathologic results. In this retrospective review of women with nipple discharge who underwent ductography between January 1, 2005 and October 30, 2015, at our institution, we compared ductography with noninvasive imaging results (mammography, ultrasound, MRI) to determine its relative diagnostic sensitivity, specificity, and relative accuracy. Diagnosis was defined from pathology results, clinical notes, and minimum of 1-year follow-up monitoring. The primary endpoints include accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. The analyses were carried out in different configurations to compare results by the following pathologic categories: cancer, high-risk lesion, intraductal papilloma (IP) without atypia, and benign pathology and/or normal imaging results. In patients with breast cancer, ductography and noninvasive breast imaging had similar sensitivities. In patients with a high-risk lesion, ductography was significantly more sensitive than noninvasive imaging modalities. In patients with intraductal papilloma without atypia, ductography was more sensitive than noninvasive imaging, but the difference was of only borderline significance. For women with benign pathology and/or normal imaging, noninvasive imaging showed a significantly higher specificity than ductography. In the absence of standard diagnostic algorithm for patients presenting with nipple discharge, the clinician has numerous options to choose a diagnostic approach that will yield the most accurate information with the least disruption to the patient. Our results indicate the value of ductography compared to value of noninvasive imaging modalities when cancer is suspected and when high risk lesion is suspected. While we show the sensitivity of ductography is similar to noninvasive imaging modalities in the setting of cancer, the sensitivity of ductography is statistically valuable for diagnosing high-risk lesions. Our hope is that this study will emphasize more research and more understanding in clinical utility and management of high-risk lesions, leading to patient-focused algorithm for diagnosing the etiology of abnormal nipple discharge.

Variations in Abnormal Nipple Discharge Management in Women- a Systematic Review and Meta-analysis

Variations in Abnormal Nipple Discharge Management in Women- a Systematic Review and Meta-analysis

Prevalencia de malignidad en las secreciones patológicas por pezón evaluadas en consulta de mastología

ObjectiveTo describe the prevalence of malignancy in patients presenting with pathologic nipple discharge (ND) attending the breast specialist clinic of San José and Infantil Universitario de San José hospitals between January 2009 and January 2015 Materials and methodsA cross-sectional cohort study conducted in patients who consulted for abnormal ND or with ND found in the clinical examination. Men and lactating and pregnant women were excluded. ResultsSeventy (70) patients consulted for abnormal ND, 38.5% had discharge from the right nipple (27 breasts), 32.8% from the left nipple (23 breasts) and 28.5% had bilateral ND (40 breasts), obtaining a total of 90 affected breasts. This complaint was the reason for consultation in 98.6%. Most of the cases were found in the premenopausal women population (47.1%, 33/70). An intraductal papilloma was the cause of ND in 16.6% and the malignancy rate found in these patients was 2.8% (2/70 patients) ConclusionsA malignant lesion must be ruled out in patients presenting with nipple discharge by performing further imaging investigations to best define medical management.

ESTUDIO DE LAS SECRECIONES MAMARIAS

Se estudia 200 pacientes afectas de telorrea, analizándose los resultados obtenidos con diferentes métodos y técnicas de diagnóstico en patología mamaria: mamografía, teletermografía, termografía en placa, citología y estudio anatomopatológico. Se resaltó el valor de la galactografía en el estudio de la patología ductal. Desde un punto de vista etiológico, la yatrogenia ocupó un lugar importante. La patología benigna (papilomas y ectasias ductales) fue la principal responsable de la secreción anómala por el pezón.

Diagnostic accuracy of abnormal galactographic and sonographic findings in the diagnosis of intraductal pathology in patients with abnormal nipple discharge

The purpose of the study was to compare the diagnostic accuracy of the combination of galactography and ultrasound in patients with pathologic nipple discharge.Fifty-six patients with pathologic nipple discharge were included in the study. Sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for each method and the combination of both were calculated. Both methods together had a sensitivity, specificity, PPV, and NPV of 91%, 17%, 61%, and 57%. The combined sensitivity of galactography and ultrasound for intraductal pathologies is higher than either modality alone, with a low specificity. No specific signs exist to predict benign or malignant lesions.

乳頭異常分泌経過観察中に顕在化した男性乳腺非浸潤性嚢胞内癌の1例

乳頭異常分泌経過観察中に顕在化した男性乳腺非浸潤性嚢胞内癌の1例

Psychological characteristics and subjective symptoms as determinants of psychological distress in patients prior to breast cancer diagnosis

The objective of this study was to determine how psychological characteristics, subjective symptoms, a family history of breast cancer, and age impact psychological distress in outpatients at the first hospital visit prior to breast cancer diagnosis. Participants were prediagnosed women with complaints of breast symptoms who either came to our hospital directly, or with a referral from another clinic. Patients were asked to complete questionnaires to determine the following: trait anxiety (State-Trait Anxiety Inventory), negative emotional suppression (Courtauld Emotional Control Scale), life stress events (Life Experiences Survey), and psychological distress (Profile of Mood States). We examined subjective symptoms (lumps, pain, abnormal nipple discharge, or deformed nipple) and family history of breast cancer based on answers to the interview sheet filled out by patients on their first visit. We analyzed a total of 154 patients who completed the questionnaires out of 237 eligible patients. A significant model was obtained by multiple regression analysis (adjusted R (2) = 0.574, p < 0.01) in which the standard partial regression coefficients for trait anxiety, suppression of anxiety, negative life change events, positive life change events, and subjective symptoms were statistically significant (beta = 0.623, 0.133, 0.155, 0.108, and 0.124, respectively; p < 0.05). Psychological distress prior to diagnosis was higher in patients who had high trait anxiety, suppression of anxiety, many life stress events, and subjective symptoms. In particular, trait anxiety had a large impact on psychological distress, underscoring the need for and importance of adequate psychological care.

Analysis of factors associated with increased psychological distress in new outpatients at the breast clinic.

Abstract Abstract #3110 Objective: To determine how psychological characteristics, subjective symptoms, and a family history of breast cancer affect the mood states of outpatients with mammary gland complains at the first hospital visit.&amp;#x2028; Participants and methods: Written consent to participate in the study was provided by 242 outpatients with mammary gland complains at Kitasato University hospital from November 2004 to January 2007. Participants either visited our hospital directly, or were referred here from another clinic. Participants were asked to complete questionnaires determining scales of the following: trait anxiety (State-Trait Anxiety Inventry-Trait; STAI-Trait), negative emotion suppression (Courtauld Emotional Control Scale; CECS), life stress events (Life Experiences Survey; LES), and mood states (Profile of Mood States; POMS) and return them either by mail or at the time of the next clinical examination. In addition, we examined subjective symptoms (lump, pain, abnormal nipple discharge, or deformed nipple) and family history of breast cancer based on answers to the interview sheet filled out by patients on their first visit to the hospital. We excluded 45 patients who submitted incomplete answers, 38 who did not reply, and 5 who were considered to be ineligible for other reasons. The analysis covered a total of 154 patients (age (years); mean=49.94, SD=12.22). Approval for this study was granted by the Institutional Review Board of Kitasato University School of Medicine and Hospital.&amp;#x2028; Results and conclusion: We performed multiple regression analysis (forced entry method) to assess how mood states (POMS score) are affected by the following factors: age at the time of first visit, trait anxiety (STAI-Trait score), emotional suppression (CECS score), number of life stress events (LES total score), number of negative evaluations of life stress events (LES balance score), subjective symptoms, and a family history of breast cancer. We obtained a significant model (adjusted R2=0.558, p&amp;lt;0.01) in which trait anxiety, emotional suppression, number of life stress events, and the standard partial regression coefficient of subjective symptoms were found to be statistically significant (beta=0.618, 0.111, 0.181, 0.118; p&amp;lt;0.05, respectively). This suggests that mood states at the first visit are less positive when patients have high trait anxiety, emotional suppression, many life stress events, and subjective symptoms. In particular, trait anxiety had a particularly large impact on mood states, indicating the importance of psychological assistance. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3110.

Breast ultrasound in the screening and diagnosis of breast cancer.

Abstract Abstract #MS3-1 Six single center and two multicenter studies of screening breast ultrasound have shown a consistent detection yield of 3-5 per 1000 for supplemental screening breast ultrasound after mammography. The vast majority of these additional cancers seen only on ultrasound are invasive, with mean tumor size of 9-11 mm across series, and, where reported, approximately 90% are node negative. Supplemental detection is mainly seen when the breast tissue is dense. Screening ultrasound carries a substantial risk of false positives, with 9-11% of biopsies prompted by ultrasound proving malignant. In the first year of the ACRIN 6666 protocol, 1 in 40 women had an unnecessary biopsy due to mammography, compared to 1 in 10 after both mammography and ultrasound. Modeling to predict impact on mortality and cost-effectiveness of screening ultrasound is in progress, and results of incidence screens in ACRIN 6666 will be forthcoming.&amp;#x2028; Ultrasound is widely used to characterize abnormalities seen on mammography and to guide biopsy, including biopsy of MRI-depicted suspicious findings. At the time of biopsy of suspicious masses, ultrasound of the ipsilateral axilla can help identify and guide FNAB of suspicious node(s) if present. In the setting of widespread malignant-appearing calcifications, ultrasound can help identify a mass which may represent an invasive component. Ultrasound has also been shown to be more accurate in identifying the source of abnormal nipple discharge than galactography. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr MS3-1.

Cutaneous application of local anaesthetic–a useful help in galactography

Galactography is an important step in the diagnostic workup of abnormal nipple discharge. At times it is impossible to insert the cannula in the secreting duct and galactography cannot be performed. In such cases we tried applying local anaesthetic spray (LA) cutaneously to the nipple followed by a further insertion attempt. LA has enabled us to insert the galactography cannula in all patients so far. We concluded that after previous unsuccessful attempts, the presented technique may relax the duct orifice and therefore permit insertion of the galactography cannula into the secreting duct.

Post-operative complications following subareolar duct clearance

Total duct excision is a common therapeutic procedure for abnormal nipple discharge. However, little information is available in the literature on complication rates. A retrospective analysis was performed on a consecutive series of 87 patients who underwent surgery for abnormal nipple discharge over a period of 45 months. A questionnaire was sent to all patients in the study group enquiring about any post-operative complications. A review of the case notes of all patients was also undertaken. Subareolar duct clearance is associated with a number of minor complications, including wound infection or breakdown, sensory loss and nipple necrosis. These complications appear to be more common in smokers.

3087: Evaluation of nipple discharge with US in correlation with galactography

Objectives: To assess the better diagnostic approach to the lesions causing nipple discharge with ultrasound (US) in correlation with galactography.Methods: We reviewed images of 33 patients with abnormal nipple discharge who underwent both galactography and US. Thirteen US were performed before galactography and 30 US were done after galactography with informations of galactographic findings. Ten patients received US twice before and after galactography on the same day. Three readers diagnosed lesions with galactogram only, and with galactogram and US together. They gave points to the latter diagnosis in comparison with the former diagnosis (−1: worse, 0: equal, 1: better, 2: detection of additional lesion). Paired US exams of 10 patients before and after galactography were graded according to three points scale (0: failure in lesion detection, 1: lesion detected but not well-characterized, 2: lesion detected and well-characterized) without information of their sequences. Scores of US before and after galactography were compared.Results: Diagnosis with galactography and US together was more accurate than galactography only (p< .05). US immediately after galactography demonstrated lesions better than US just before galactography (p< .05).Conclusions: We recommend combination of galactography and US immediately after galactography in evaluation of lesions with abnormal nipple discharge. Objectives: To assess the better diagnostic approach to the lesions causing nipple discharge with ultrasound (US) in correlation with galactography. Methods: We reviewed images of 33 patients with abnormal nipple discharge who underwent both galactography and US. Thirteen US were performed before galactography and 30 US were done after galactography with informations of galactographic findings. Ten patients received US twice before and after galactography on the same day. Three readers diagnosed lesions with galactogram only, and with galactogram and US together. They gave points to the latter diagnosis in comparison with the former diagnosis (−1: worse, 0: equal, 1: better, 2: detection of additional lesion). Paired US exams of 10 patients before and after galactography were graded according to three points scale (0: failure in lesion detection, 1: lesion detected but not well-characterized, 2: lesion detected and well-characterized) without information of their sequences. Scores of US before and after galactography were compared. Results: Diagnosis with galactography and US together was more accurate than galactography only (p< .05). US immediately after galactography demonstrated lesions better than US just before galactography (p< .05). Conclusions: We recommend combination of galactography and US immediately after galactography in evaluation of lesions with abnormal nipple discharge.

Mammary ductoscopy by helical CT: -Initial experience-

An attempt was made to visualize minute intraductal lesions using helical CT in patients with abnormal nipple discharge. Galactography was performed, immediately followed by CT (ductal CT examination). Based on the image data obtained, ductal images were constructed on a workstation using a Pegasus viewer (ductal CT imaging). Since no criteria for diagnosis by this method are available, ductal CT images were diagnosed by reference to the known ductal fiberscopic findings. Ductal CT examination was performed in 10 cases, in 9 of whom ductal CT images were successfully constructed. Pathological examination was performed in 8 cases. It was possible to observe the structure of the luminal surface on the constructed ductoscopic images from all directions, but the color tone or the presence or absence of hemorrhage could not be observed. In the examination for abnormal nipple discharge, ductal CT examination was useful for intraductal observation. Currently, it is a method that allows for observation of the most minute intraductal lesions. However, some issues still remain unresolved. The results of this study suggest that further studies with more cases hold the promise of making ductal CT imaging a useful examination method.

Mammary Ductoscopy by Helical CT: -Initial Experience-

Background: An attempt was made to visualize minute intraductal lesions using helical CT in patients with abnormal nipple discharge.Methods: Galactography was performed, immediately followed by CT (ductal CT examination). Based on the image data obtained, ductal images were constructed on a workstation using a Pegasus viewer (ductal CT imaging). Since no criteria for diagnosis by this method are available, ductal CT images were diagnosed by reference to the known ductal fiberscopic findings.Results: Ductal CT examination was performed in 10 cases, in 9 of whom ductal CT images were successfully constructed. Pathological examination was performed in 8 cases. It was possible to observe the structure of the luminal surface on the constructed ductoscopic images from all directions, but the color tone or the presence or absence of hemorrhage could not be observed.Conclusions: In the examination for abnormal nipple discharge, ductal CT examination was useful for intraductal observation. Currently, it is a method that allows for observation of the most minute intraductal lesions. However, some issues still remain unresolved. The results of this study suggest that further studies with more cases hold the promise of making ductal CT imaging a useful examination method.

Clinical application of breast fiberoptic ductoscopy in 354 cases with abnormal nipple discharge

OBJECTIVE To use the breast duct endoscope for studying the pathological characteristics of breast-duct disease with nipple discharge, and offer methods that can improve diagnostic accuracy. METHODS A total of 354 patients with nipple discharge were examined using the fiberoptic duct endoscope (FVS-3000M). Ducts and their branches were investigated to define and locate the extent of intraductal lesions. Core biopsies were taken of suspicious lesions and the findings were analyzed retrospectively. RESULTS In cases of bloody and serosanguineous nipple discharge, 72.3% were papilloma and papillomatosis, 5.2% duct cancer and 22.5% mammary duct ectasia and galactophoritis. In patients with watery nipple discharge,56.0% were papilloma and papillomatosis, 8.0% were breast cancer and 5 patients without abnormal findings were regarded as normal. CONCLUSION Fiberoptic duct endoscopy can accurately locate the site and pathology of nipple discharge allowing the improvement in diagnosis of early breast cancer.

Assessment of the abnormal lactiferous duct

The lactiferous duct system of the breast is the site of development of various benign and malignant lesions. Asymptomatic patients may have incidental diagnosis of ductal dilation on mammography. A mass or area of calcifications identified on mammography as suspicious and subsequently biopsied may represent a lesion of a primary lactiferous duct. The smaller terminal ducts are the site of development of most cancers and hyperplasias. In patients who present with the symptom of nipple discharge, a clinical assessment is made to determine the potential significance of the finding. In patients with uniorificial, spontaneous and suspicious discharge, further evaluation with galactography is recommended. In this article we will review the benign and malignant lesions of the main lactiferous ducts, the assessment of asymptomatic patients with ductal dilation on mammography, and the assessment of patients with abnormal nipple discharge.