Management Of Nipple Discharge Research Articles

Surgical outcomes of total duct excision in the diagnosis and management of nipple discharge.

Total duct excision (TDE) is performed for the diagnosis and management of nipple discharge. The Association of Breast Surgery's recent guidelines recommend considering diagnostic surgery for single-duct, blood-stained or clear nipple discharge, and for symptomatic management. We retrospectively reviewed the diagnostic and surgical outcomes of all cases of TDE between January 2013 and November 2019. In total, 259 TDEs were carried out: 219 for nipple discharge, 29 for recurrent mastitis, 3 for screening abnormalities and 8 for breast lumps. Of the nipple discharge group, 121 had blood-stained discharge. Mean patient age was 52 years (range 19-81). Median follow-up time was 45 months (interquartile range 24-63). The following cases were identified on histopathology: 236 benign breast changes, 10 atypical ductal hyperplasia, 4 lobular carcinoma in situ, 2 low-grade ductal carcinoma in situ (DCIS), 3 intermediate-grade DCIS, 2 high-grade DCIS and 2 invasive ductal carcinomas. In total, 3.5% of patients who underwent TDE had a diagnosis of DCIS or invasive carcinoma. Blood-stained discharge was associated with a significant increase in risk of DCIS or carcinoma compared with other nipple discharge colours (p = 0.043). The most common complications of TDE were infection, poor wound healing and haematoma. Nipple discharge recurred in 14.2% of cases. TDE can be considered for the diagnostics and management of nipple discharge. Blood-stained nipple discharge increases the risk of DCIS or malignancy, but the majority of the time TDE reveals benign breast pathology.

In the management of nipple discharge should we advise microdochectomy or total duct excision?

Introduction: Nipple discharge is a common symptom presenting to the breast clinic. Current investigations involve combination of ultrasound and mammogram dependent on age. In persistent cases surgical excision of the discharging ducts is recommended. Our study aimed to evaluate the effectiveness of either microdochectomy or total duct excision (TDE) in the investigation of persistent nipple discharge.

The role of major duct excision and microdocectomy in the management of nipple discharge: Diagnostic and therapeutic approach

Mammary duct ectasia is considered as a benign condition of the mammary gland. Many theories analyses and summarized the disease regarding the pathogenesis. Firstly, the primary pathological process is due to be involutional and atrophy of the ducts. Other cause of dilation of the ducts, leading to the decrease or absent of secretion, inflammation and duct rupture. Secondly, the causative factor is inflammatory process with periductal inflammation followed by obliteration of ducts, sclerosis of duct and surrounding tissue and duct ectasia. Mostly mammary duct ectasia resolves without any treatment. Applying light warm compresses to nipple and wearing a supportive bra, can help to reduce discomfort of the patient. But If there is evidence of an infection, antibiotics will be prescribed without hesitation. It’s completely prohibited to squeeze the area to increase discharge, as there is increase chance to develop inflammation and infection. If symptoms still persisted than surgery may be done to disconnect the ducts and remove the ducts, Known as Hadfield’s operation. Recently sub-areolar major mammary duct excision – Hadfield’s procedure is very popular and has gained widespread acceptance in management of nipple-areola complex problems like suspicious or troublesome discharge, clinical or sono-mammographic central anomalies and chronic sinus-fistula. Here two cases with nipple discharge managed with two very common surgery with microdocectomy and total duct excision held in Z.H Sikder Women’s Medical College Hospital. Patients were very satisfied with the treatment as they got relief of symptoms and most importantly get rid of the fear of carcinoma.

Anti-hyperprolactinemic activities of aqueous extract of Uvaria chamae (P. Beauv) roots and associated biochemical changes in chlorpromazine-induced hyperprolactinemic female Wistar rats

Ethnopharamcological relevanceThe age-long folkloric use of Uvaria chamae roots in the management of nipple discharge that is not related to pregnancy, childbirth or nursing but as a result of excessive production of prolactin (hyperprolactinemia) is yet to be substantiated with scientific data. Aim of the studyThis study investigated the anti-hyperprolactinemic activities of aqueous extract of Uvaria chamae roots (AEUCR) and associated biochemical changes in chlorpromazine (CPZ)-induced hyperprolactinemic female Wistar rats. Materials and methodsA total of sixty female rats (207.40 ± 2.69 g) were assigned into 6 groups: A-F. Animals in Group A received 0.5 ml of distilled water only whilst the 7 days CPZ-treated female rats (to induce hyperprolactinemia) in groups B, C, D, E, and F also received distilled water, 2.5 mg/kg body weight of bromocriptine (reference drug), 0.71, 1.41 2.83 mg/kg body weight of AEUCR for 28 days. ResultsAEUCR contained a total of 15 (75%) amino acids with seven (46.67%) being essential amino acids and eight (53.33%) as non-essential amino acids. Administration of CPZ increased (p < 0.05) the levels of prolactin and testosterone, and reduced (p < 0.05) the levels of estradiol, progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), dopamine, triiodothyronine (T3) and tetraiodothyroxine (T4). Chlorpromazine also increased the levels of serum urea, creatinine, total protein, albumin, globulin, bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) of the animals. In contrast, AEUCR significantly (p < 0.05) reduced the CPZ-induced increases in the levels of prolactin and testosterone, and increased the levels of CPZ-induced reduction in the progesterone, estradiol, FSH, LH, dopamine, T3 and T4. The AEUCR also reversed (p < 0.05) the CPZ-induced related increases in the levels of urea, creatinine, total protein, albumin, globulin, bilirubin, ALT, AST and ALP similar to the trends in the distilled water- and bromocriptine-treated controls. The CPZ-induced remarkable increase in the size of lactating alveolus and lactiferous duct distribution in the mammary gland were restored to normal tubule-alveolar female pattern mammary glands, composed of branching ducts and small alveoli budding off the ducts. ConclusionThe study concluded that aqueous extract of Uvaria chamae root exhibited anti-hyperprolactinemic activity by restoring prolactin and dopamine levels and tubule-alveolar female pattern in female rats. It also ameliorated CPZ-induced changes in the liver and kidney function indices. This study justifies the folkloric use of Uvaria chamae root in the management of abnormal discharge by the nipples that is unrelated to pregnancy, childbirth and nursing.

P151: Surgical outcomes of total duct excision in the diagnostics and management of nipple discharge

Introduction: Total Duct Excision (TDE) is performed for diagnostics and management of nipple discharge. Recent Association of Breast Surgery (ABS) guidelines recommend considering surgery for single-duct blood-stained or clear nipple discharge, and for symptomatic management.

Management of Nipple Discharge: Our experience

Introduction Nipple discharge continues to be a bothersome complaint by the patients. Nipple discharge is associated with non malignant causes as well and needs proper evaluation and treatment. We conducted a study in our departement to analyse the various management options for patients suffering from various types of nipple discharge. Patients and methods: Patients presenting with complaints of nipple discharge, either spontaneous or non spontaneous in the age group of 15-55 years were included in the study. Patients with breast cancer , lump or abscess were excluded. Results A total of 66 patients with mean age of 39 were selected for analysis. Mean age of the patient was 39 years. 32 patients (48.4%) had greenish discharge, 16 (24.4 %) had bloody discharge, 12 (18.2%)had clear discharge and 6 (9.09%) had milky discharge. Cytology and Imaging of the patients were done according to the age of the patient. of discharging fluid was done in all cases which revealed epithelial cells in 38 (%), duct papilloma in 16 (24.4), histiocytes in 10 (15.1%) and atypical cells in 2 (3.03%) patients. Ultrasonography of the breast was done in 36 (54.5%), X ray mammography in 30 (45.5%) patients. A total of 27 (40.9%) patients underwent surgery, of whom 12 (18.2%) were subjected to microdochotomy and 15 (22.7%) to hadfield’s operation. The histopathology of the resected specimen revealed duct papilloma in 16 (24.4%) patients, duct ectasia in 10 (15.1%) and ductal carcinoma in situ in 1 (1.1%) patient. Conclusion: Management of nipple discharge is complex and involves multi disciplinary approach. Majority of patients can be managed conservatively, however a significant number of patients need surgical treatment as well.

Galactogram Grading System for Identifying Breast Cancer With Nipple Discharge

BackgroundGalactography is a primary recommendation in the management of nipple discharge (ND), which may be caused by benign or malignant lesions. We aimed to establish a galactogram grading system (GGS) and investigate its role in identifying breast cancer with ND. Patients and MethodsA total of 350 patients were included in our study. All patients received preoperative mammographic galactography successfully and underwent surgery at Qilu Hospital of Shandong University between January 2011 and August 2015. We first performed a retrospective study in a consecutive series of 250 patients with ND to establish a GGS. Then the subsequent consecutive series of 100 patients was analyzed to validate the grading system. ResultsOur data showed that the GGS can well assess the risk of a galactogram's being malignant. Galactograms classified into grade I have a lower risk of being malignant, while those classified into grade III have a higher risk of being malignant. Thus, our GGS was useful for distinguishing malignant from benign lesions. ConclusionWe established a scoring system for breast disease with ND. This GGS may be a novel approach for identifying breast cancer with ND.

Diagnostic Role of the Presence of Red Blood and Epithelial Cells in Nipple Discharge Cytology

Introduction: Management of nipple discharge (ND) is variable reflecting the lack of a uniformly accepted assessment policy. The aim of this study was to determine the common underlying pathology in patients presenting with ND as well as to evaluate the diagnostic role of red blood cells (RBC) and epithelial cells in the nipple cytology (NC). Methodology: Electronic data base held at Leeds Teaching Hospitals NHS Trust was searched to identify all the patients who underwent Hadfield’s (open diagnostic major duct excision) procedure for ND from January 2004 to December 2009. We included only patients with ND as the primary symptom and excluded those with any underlying palpable or radiological abnormality. Results: Hadfield’s procedure was performed in 120 cases (Median age=49 years; range=20-88). The final histology showed benign changes (duct ectasia/hyperplasia and fibrocystic changes) in most (37.5%), followed by intra-ductal papilloma (32.5%), normal (16.6%), malignant (10.9%) and atypical (2.5%) changes in the rest. The presence of RBC in NC was 87% sensitive to detect any underlying pathology and 69% sensitive to predict malignancy at the expense of specificity. However, epithelial cells were found to be neither sensitive nor specific enough to detect underlying pathology or malignancy. Conclusion: The aetiology remains benign in most patients presenting with ND in the absence of any underlying palpable or radiological abnormality. Even in patients without an underlying radiological abnormality, diagnostic surgery should be offered if RBC is present in the nipple cytology.

The Predictive Value of Ductography and Magnetic Resonance Imaging in the Management Of Nipple Discharge

The Predictive Value of Ductography and Magnetic Resonance Imaging in the Management Of Nipple Discharge

The Predictive Value of Ductography and Magnetic Resonance Imaging in the Management of Nipple Discharge

Standard evaluation (physical examination, mammography, sonography) often fails to identify an underlying lesion in patients with suspicious nipple discharge. The aim of this study was to determine the predictive value of ductography (DG) and magnetic resonance imaging (MRI) in this setting. Using ICD-9 codes, we retrospectively identified 376 patients who presented with suspicious nipple discharge (ND) (1995-2005); 306 patients (68%) had negative standard evaluation. Among 306 patients, 186 (61%) underwent further evaluation with DG (n = 163) and/or MRI (n = 52), 35 (11%) underwent major duct excision alone (MDE), and 85 (28%) were followed clinically. Ultimately, 182/306 (59%) patients underwent surgery and/or biopsy. Overall incidence of malignant or high-risk pathology was 15% (46/306). DG was completed in 139/163 (85%) studies and detected 12 cancers and seven high-risk lesions (HRL), but failed to identify four cancers and 2 HRL (PPV 19%, NPV 63%). MRI detected seven cancers and three HRL, but failed to identify one cancer and one HRL (PPV 56%, NPV 87%). MDE alone (n = 35) detected five cancers and three HRL. Of all patients not having surgery, (142/306, 41%), one (0.01%) presented with an invasive cancer at 102 months (median follow-up, 6.3 months; range, 0-124 months). An underlying malignancy was identified in 30/306 (10%) patients with ND and negative standard evaluation. Ductography is a poor predictor of underlying pathology and cannot exclude malignancy. MRI's higher predictive values may allow for improved patient selection and treatment planning; however, MRI should not replace MDE as the gold standard to exclude malignancy in patients with ND and negative standard evaluation.

NIPPLE DISCHARGE

The evaluation and management of nipple discharge can be undertaken with minimal difficulty by performing a careful history and examination and following a logical thought process in linking the type of discharge with the suitable mode of treatment. In this manner, the patient’s discharge can be efficiently and thoroughly evaluated.

Management of nipple discharge by clinical Findings

Management of nipple discharge by clinical Findings

Management of nipple discharge by clinical findings

In a review of 249 office patients who complained of nipple discharge, breast nodularity and duct ectasia was the cause in three quarters. The clinical diagnosis was made by observing that more than one duct was involved and by the color of the discharge. On average, the patients were 10 years younger than those with cysts and 20 years younger than those with carcinoma. In half, the discharge could persist or recur for months or years. Nipple discharge was not commonly associated with carcinoma, and when it was, the carcinoma was almost always palpable. Nipple discharge, including bloody discharge, should be regarded as a sign of a benign breast disorder, not of breast cancer. Duct papillomas can be recognized by exploring the single profusely discharging duct, regardless of the color of the discharge. Other than patients with an obvious lump, the only patients who require surgical exploration are those with a single profusely discharging duct, not because cancer is a significant possibility but merely to rid the patient of the nuisance of the continuing discharge from a duct papilloma. Of 249 patients with nipple discharge, breast nodularity and duct ectasia was the cause in 75 percent. The median age of these patients was the mid 30s. The discharge was chronic or recurring in half. Only 4 percent of all the patients with nipple discharge had an associated breast cancer. When cancer was present, an obvious lump was usually palpable. Bloody discharge was much more likely to be associated with benign breast disorders than cancer. A single profusely discharging duct should be explored regardless of the discharge color because of the likelihood of finding a duct papilloma.