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Pathologic Nipple Discharge: Surgery Is Imperative in Postmenopausal Women

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Abstract

Background

A total of 10% to 15% of pathologic nipple discharge in women is due to malignant lesions of the breast. The purpose of this study was to discover the rate of breast cancer in women who present with this symptom and undergo ductal excision, to evaluate the different diagnostic methods used before surgery, and to discover whether there are specific factors with regard to dignity.

Methods

We analyzed 118 ductal excisions in 116 patients performed at the women’s hospital of the University of Rostock, Germany, between 1995 and 2002. The discharging duct was identified by preoperative galactography.

Results

The rate of cancer in these patients was 9.3% (n = 11). The most frequent benign lesion was intraductal papillomatous proliferation (36.4%; n = 43). Solitary papillomas were shown in 21.2% (n = 25), and other specific benign histologic findings were shown in 27.1% (n = 32). Women with malignancies were significantly older (P = .009) and were more often postmenopausal (P = .095) compared with patients with benign histology. Galactography was the method that reached the highest sensitivity (73%), and clinical examination showed the highest specificity (85%) in distinguishing between benign and malignant lesions.

Conclusions

Because 94.1% of all cases presented with specific histological findings causing pathologic nipple discharge, ductal excision combined with preoperative galactography was proven to be a sufficient method for diagnosis and therapy. This procedure should be performed in all postmenopausal women with this symptom because of a cancer rate of 12.7% among this age group and the unsatisfactory quality of other diagnostic methods.

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References

  1. KJ Van Zee G Ortega Perez E Minnard MA Cohen (1998) ArticleTitlePreoperative galactography increases the diagnostic yield of major duct excision for nipple discharge Cancer 28 1174–80

    Google Scholar 

  2. HP Leis FL Greene A Cammarata SE Hilfer (1988) ArticleTitleNipple discharge: surgical significance South Med J 81 20–6 Occurrence Handle3336795

    PubMed  Google Scholar 

  3. HI Vargas L Romero RT Chlebowski (2002) ArticleTitleManagement of bloody nipple discharge Curr Treat Options Oncol 3 157–61 Occurrence Handle12057078

    PubMed  Google Scholar 

  4. GH Sakorafas (2001) ArticleTitleNipple discharge: current diagnostic and therapeutic approaches Cancer Treat Rev 27 275–82

    Google Scholar 

  5. MA Funovics MO Pilipp B Lackner M Fuchsjaeger PT Funovics V Metz (2003) ArticleTitleGalactography: method of choice in path- ologic nipple discharge? Eur Radiol 13 94–9 Occurrence Handle1:STN:280:DC%2BD3s%2FjtlKhsg%3D%3D Occurrence Handle12541115

    CAS  PubMed  Google Scholar 

  6. MG Florio T Manganaro A Pollicino P Scarfo B. Micali (1999) ArticleTitleSurgical approach to nipple discharge: a ten-year experience J Surg Oncol 71 235–8 Occurrence Handle10.1002/(SICI)1096-9098(199908)71:4<235::AID-JSO5>3.0.CO;2-# Occurrence Handle1:STN:280:DyaK1MzntVWhtg%3D%3D Occurrence Handle10440761

    Article  CAS  PubMed  Google Scholar 

  7. M Grillo E Lehmann-Willenbrock HJ. Gent (1990) ArticleTitleChromogalactography preceding ductal-lobular unit excision for nipple discharge—with special reference to diagnostic galactography and histology Ann Chir Gynaecol 79 6–9 Occurrence Handle1:STN:280:By%2BB1M%2Fit1U%3D Occurrence Handle2357057

    CAS  PubMed  Google Scholar 

  8. HP Dinkel (2000) ArticleTitleFeatures of benign and malignant breast disease in galactography Radiologist 7 247–57

    Google Scholar 

  9. AO Saarela HO Kiviniemi TJ Rissanen (1997) ArticleTitlePreoperative methylene blue staining of galactographically suspicious breast lesions Int Surg 82 035

    Google Scholar 

  10. LG Dawes C Bowen LA Venta M Morrow (1998) ArticleTitleDuctography for nipple discharge: no replacement for ductal excision Surgery 124 685–91 Occurrence Handle10.1067/msy.1998.91362 Occurrence Handle1:STN:280:DyaK1cvlsVaktg%3D%3D Occurrence Handle9780989

    Article  CAS  PubMed  Google Scholar 

  11. MF Hou CJ Huang YS Huang et al. (1998) ArticleTitleEvaluation of galactography for nipple discharge Clin Imaging 22 89–94 Occurrence Handle10.1016/S0899-7071(97)00094-6 Occurrence Handle1:STN:280:DyaK1c3gsFWltA%3D%3D Occurrence Handle9543584

    Article  CAS  PubMed  Google Scholar 

  12. HP Dinkel AM Gassel T Müller S Lourens M Rominger A Tschammler (2001) ArticleTitleGalactography and exfoliative cytology in women with abnormal nipple discharge Obstet Gynecol 97 625–9 Occurrence Handle10.1016/S0029-7844(00)01229-1 Occurrence Handle1:STN:280:DC%2BD3M7oslCktg%3D%3D Occurrence Handle11275040

    Article  CAS  PubMed  Google Scholar 

  13. MH Seltzer LJ Perloff RI Kelley WT Fitts (1970) ArticleTitleThe significance of age in patients with nipple discharge Surg Gynecol Obstet 131 519–22 Occurrence Handle1:STN:280:CS%2BB2sbjsVM%3D Occurrence Handle5454537

    CAS  PubMed  Google Scholar 

  14. MH Seltzer (2004) ArticleTitleBreast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals Breast J 10 111–7 Occurrence Handle10.1111/j.1075-122X.2004.21284.x Occurrence Handle15009037

    Article  PubMed  Google Scholar 

  15. N Cabioglu KK Hunt SE Singletary et al. (2002) ArticleTitleUtility of imaging techniques in surgical treatment and diagnosis of breast carcinoma in women presenting with nipple discharge Breast Cancer Res Treat 76 IssueID (Suppl 1) S94

    Google Scholar 

  16. KW Shen J Wu JS Lu et al. (2000) ArticleTitleFiberoptic ductoscopy for patients with nipple discharge Cancer 89 1512–9 Occurrence Handle10.1002/1097-0142(20001001)89:7<1512::AID-CNCR14>3.0.CO;2-L Occurrence Handle1:STN:280:DC%2BD3cvmslSktg%3D%3D Occurrence Handle11013365

    Article  CAS  PubMed  Google Scholar 

  17. D Yamamoto T Shoij H Kawanishi et al. (2001) ArticleTitleA utility of ductography and fiberoptic ductoscopy for patients with nipple discharge Breast Cancer Res Treat 70 103–8 Occurrence Handle10.1023/A:1012990809466 Occurrence Handle1:STN:280:DC%2BD38%2Fkt1Cktw%3D%3D Occurrence Handle11768599

    Article  CAS  PubMed  Google Scholar 

  18. D Yamamoto S Ueda H Senzaki et al. (2001) ArticleTitleNew diagnostic approach to intracystic lesions of the breast by fiberoptic ductoscopy Anticancer Res 21 4113–6

    Google Scholar 

  19. ER Sauter H Ehya L Schlatter B MacGibbon (2004) ArticleTitleDuctoscopic cytology to detect breast cancer Cancer J 10 15–6

    Google Scholar 

  20. H Nakahara K Namba R Watanabe et al. (2003) ArticleTitleA comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge Breast Cancer 10 320–9 Occurrence Handle14634510

    PubMed  Google Scholar 

  21. SG Orel CS Dougherty C Reynolds BJ Czerniecki ES Siegelman MD Schnall (2000) ArticleTitleMR imaging in patients with nipple discharge: initial experience Radiology 216 248–54 Occurrence Handle1:STN:280:DC%2BD3czksl2rsg%3D%3D Occurrence Handle10887256

    CAS  PubMed  Google Scholar 

  22. BL Daniel RW Gardner RL Birdwell KW Nowels D Johnson (2003) ArticleTitleMagnetic resonance imaging of intraductal papilloma of the breast Magn Reson Imaging 21 887–92 Occurrence Handle10.1016/S0730-725X(03)00192-9 Occurrence Handle14599539

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Rostock, Universitätsfrauenklinik, Suedring 81, 18059, Rostock, Germany

    Steffi Lau MD, Angrit Stachs MD & Toralf Reimer MD

  2. Institute of Radiology, University of Rostock, P.O. Box 100888, 18055, Rostock, Germany

    Ingrid Küchenmeister MD

  3. Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Campus Innenstadt, Maistr. 11, 80337, Munich, Germany

    Bernd Gerber PhD & Annette Krause MD

Authors
  1. Steffi Lau MD
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  2. Ingrid Küchenmeister MD
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  3. Angrit Stachs MD
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  4. Bernd Gerber PhD
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  5. Annette Krause MD
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  6. Toralf Reimer MD
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Correspondence to Steffi Lau MD.

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Lau, S., Küchenmeister, I., Stachs, A. et al. Pathologic Nipple Discharge: Surgery Is Imperative in Postmenopausal Women. Ann Surg Oncol 12, 546–551 (2005). https://doi.org/10.1245/ASO.2005.04.013

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  • DOI: https://doi.org/10.1245/ASO.2005.04.013

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