Traditional and Innovative Management of Pathologic Nipple Discharge - Kyuchukov N., Dimitrova A., Iliev S., Inkov I., Dobrichkov L., Tsvetanov S. - MySurgery.bg 2012, 2:1279 (12 October 2012)

Nipple discharge (ND) is the third most common breast complaint following breast mass and mastodynia. ND is distressing to patients due to the fear of possible breast cancer. It occurs when fluid inside the milk ducts is elicited by massage or a spontaneous process. Depending on the presentation and quantity, the discharge can be normal or caused by an underlying pathology. There are seven basic types of ND: milky, multicolored and sticky, purulent, watery, serous, serosanguineous, and sanguineous. The last four are most often caused by underlying breast pathology and require surgical treatment.

Aim

The aim of the present study is to analyze the surgical management of patients with pathologic ND at the Thoracic Surgery Clinic of the Military Medical Academy in Sofia, Bulgaria.  The pathologic characteristics and the surgical management are examined.

Methods

A retrospective methodology was employed in order to analyze 102 records of patients presenting with ND, operated from January 2009 to April 2012.  For each case, data from the classical triad of diagnostic methods was gathered: anamnestic data indicating the physical examination and history, imaging data from ultrasonography and/or mammography, and data from the cytological examination of ND.  In some cases where malignancy was suspected ductal lavage and mammary ductoscopy were also used. 

Results

Lastly following each surgical procedure the initial diagnosis was matched with the histological result. Pathologic findings of women with ND revealed solitary papilloma in 26 cases, invasive breast cancer in 3, DCIS in 3, LCIS in 1, fibrocystic disease in 29 , papillomatosis in 9, ductal hyperplasia in 19, and finally duct ectasia in 12 cases. The preoperative diagnosis was matched with the histological result in 86% of the cases. Regardless of the fact that ND is not a common cause of cancer, clinicians should be proactive about this condition.  The evaluation and diagnosis of ND are important for the early detection of carcinoma.  Anamnestic, imaging, and cytologic data should continue to be the gold standard for diagnosis, however most ND are the result of a clinically insignificant benign process.

Conclusion

This study reveals that ductal lavage and mammary ductoscopy are innovative techniques that show promise as they are less invasive, nevertheless accurate diagnostic modalities.  In all cases of persistent pathological ND, suspective neoplasm or breast cancer, surgical intervention remains the best treatment modality.  When cancer is present surgery still remains the best option, however these early diagnostic modalities may change or reduce the need for radical surgical intervention.

Keywords

 pathologic nipple discharge, papilloma, papillomatosis, fibrocystic disease, ductal hyperplasia, duct ectasia, ductal carcinoma in situ, lobular carcinoma in situ, ultrasonography, mammography, surgery, ductal lavage, ductoscopy

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