Skip to main content
SpringerLink
Log in
Book cover

Management of Breast Diseases pp 53–67Cite as

Nipple Discharge

  • Chapter

  • 1978 Accesses

Abstract

Nipple discharge is a presenting complaint of between 3–7.4% of women seeking medical care for breast problems [1, 2]. While the majority of these patients will have a benign process, nipple discharge can be the sole sign of cancer in 1% of patients [3]. The evaluation and treatment of nipple discharge varies greatly in practice and in the literature, causing confusion for both patients and physicians. Differentiating between physiologic and pathologic nipple discharge is critical in order to identify patients in need of a diagnostic work-up and treatment plan.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Devitt JE (1985) Management of nipple discharge by clinical findings. Am J Surg. 149:789

    Article  CAS  PubMed  Google Scholar 

  2. Gulay H, Bora S, Kilicturgay S, Hamaloglu E, Goskel HA (1994) Management of nipple discharge. J Am Coll Surg. 178:471–4

    CAS  PubMed  Google Scholar 

  3. Chaudary M, Millis R, Davies G et al (1982) Nipple discharge: the diagnostic value of testing for occult blood. Ann Surg. 196:651

    Article  CAS  PubMed  Google Scholar 

  4. Goodson WH, King EB (1998) Discharges and secretions of the nipple. In: Bland KI, Copeland EM (eds) The breast: comprehensive management of benign and malignant diseases., 2nd edn, WB Saunders, Philadelphia, pp 51–74

    Google Scholar 

  5. Sartorius OW, Smith HS, Morris P et al (1977) Cytological evaluation of breast fluid in the detection of breast diseases. J Natl Cancer Inst. 59:1073–80

    CAS  PubMed  Google Scholar 

  6. Sauter ER, Daly M, Linahan K et al (1996) Prostate-specific antigen levels in nipple aspirate fluid correlate with breast cancer risk. Cancer Epidemiol Biomark Prev. 5(120): 967–70

    CAS  Google Scholar 

  7. Petrakis NL, Mason L, Lee R (1975) Association of race, age, menopausal status, and cerumen type with breast fluid secretion in nonlactating women as determined by nipple aspiration. J Natl Cancer Inst. 54:829–34

    CAS  PubMed  Google Scholar 

  8. Sauter E, Wagner-Mann C, Ehya H et al (2007) Biologic markers of breast cancer in nipple aspirate fluid and nipple discharge are associated with clinical findings. Cancer Detect Prev. 31(1):50–8

    Article  PubMed  Google Scholar 

  9. Wrensch MR, Petrakis NL, Gruenke LD et al (1990) Factors associated with obtaining nipple aspirate fluid: analysis of 1,428 women and literature review. Breast Cancer Res Treat. 15(1):39–51

    Article  CAS  PubMed  Google Scholar 

  10. Lang J, Kuerer H (2007) Breast ductal secretions: clinical features, potential uses, and possible applications. Cancer Control. 14(4):350–9

    PubMed  Google Scholar 

  11. Petrakis NL (1986) Physiologic, biochemical, and cytologic aspects of nipple aspirate fluid. Breast Cancer Res Treat. 8:7–19

    Article  CAS  PubMed  Google Scholar 

  12. Papanicolaou GN, Bader GM, Holmquist DG (1958) Exfoliative cytology of the human mammary gland and its value in the diagnosis of cancer and other diseases of the breast. Cancer. 11:337–409

    Article  Google Scholar 

  13. Petrakis NL, Lee RE, Miike R et al (1988) Coloration of breast fluid related to concentration of cholesterol, cholesterol epoxides, estrogens and lipid peroxides. Am J Clin Pathol. 89:117–20

    CAS  PubMed  Google Scholar 

  14. Santen RJ, Mansel R (2005) Benign Breast disorders. N Engl J Med. 353(3):275–85

    Article  CAS  PubMed  Google Scholar 

  15. Seltzer MH (2004) Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J. 10:111–7

    Article  PubMed  Google Scholar 

  16. Dillon M, NaMohd Nazri S, Nasir S et al (2006) The role of major duct excision and microdochectomy in the detection of breast carcinoma. BMC Cancer. 6:164

    Article  PubMed  Google Scholar 

  17. Ciatto S, Bravetti P, Cariaggi P (1986) Significance of nipple discharge clinical patterns in selection of cases for cytologic examination. Acta Cytologica. 30(1):17–20

    CAS  PubMed  Google Scholar 

  18. Leis HP Jr (1989) Management of nipple discharge. World J of Surg. 13(6):736–42

    Article  Google Scholar 

  19. Tabar L, Dean PB, Pentek Z (1983) Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 149:31–8

    CAS  PubMed  Google Scholar 

  20. Dawes LG, Bowen C, Luz VA, Morrow M (1998) Ductography for nipple discharge: no replacement for ductal excision. Surgery. 124(4):685–91

    Article  CAS  PubMed  Google Scholar 

  21. Paterok EM, Rosenthal H, Sabel M (1993) Nipple discharge and abnormal galactogram. Results of a long-term study (1964–1990). Eur J Obstet Gynecol Reprod Biol. 50: 227–34

    Article  CAS  PubMed  Google Scholar 

  22. Lau S, Kuchenmeister I, Stachs A et al (2005) Pathologic nipple discharge: surgery is imperative in postmenopausal women. Ann Surg Oncol. 12(7):246–51

    Article  Google Scholar 

  23. Vargas H, Perla Vargas M, Eldrageely K et al (2006) Outcomes of clinical and surgical assessment of women with pathological nipple discharge. Am Surg. 72:124–8

    PubMed  Google Scholar 

  24. Cabioglu N, Hunt KK, Singletary SE et al (2003) Surgical decision-making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. Am Coll Surg. 196(3):354–64

    Article  Google Scholar 

  25. Carty NJ, Mudan SS, Ravichandran D, Royle GT, Taylor I (1994) Prospective study of outcome in women presenting with nipple discharge. Ann R Coll Surg Engl. 76:387–9

    CAS  PubMed  Google Scholar 

  26. Dietz JR, Crowe JP, Grundfest S et al (2002) Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery. 132:582–7

    Article  PubMed  Google Scholar 

  27. Johnson TL, Kini SR (1991) Cytologic and Clinicopathologic features of abnormal nipple secretions: 225 cases. Diagn Cytopathol. 7:17–22

    Article  CAS  PubMed  Google Scholar 

  28. Copeland M, Higgins T (1960) Significance of discharge from the nipple in nonpuerperal mammary conditions. Ann Surg. 151(5):638–48

    Article  CAS  PubMed  Google Scholar 

  29. Arnold G, Neiheisel M (1997) A comprehensive approach to evaluating nipple discharge. Nurse Pract. 22(7):96–111

    Article  CAS  PubMed  Google Scholar 

  30. Newman HF, Klein M, Northrup JD et al (1983) Nipple discharge: frequency and pathogenesis in an ambulatory population. NY St J Med. 83:928

    CAS  Google Scholar 

  31. Haagensen DD (1971) Diseases of the breast, 2nd edn. WB. Saunders, Philadelphia

    Google Scholar 

  32. Zuska JJ, Crile G Jr. Ayres NW (1951) Fistulas of lactiferous ducts. Am J Surg. 81:312–7

    Article  CAS  PubMed  Google Scholar 

  33. Fiorica JV (1994) Nipple discharge. Obstet Gynecol Clin North Am. 21:453–60

    CAS  PubMed  Google Scholar 

  34. Liu GY, Lu JS, Shen KW, Wu J, Chen CM et al (2008) Fiberoptic ductoscopy combined with cytology testing in the patients of spontaneous nipple discharge. Breast Cancer Res Treat. 108:271–7

    Article  PubMed  Google Scholar 

  35. Lafreniere R (1990) Bloody nipple discharge during pregnancy and/or lactation: a rational for conservative treatment. J Surg Oncol. 43:228–30

    Article  CAS  PubMed  Google Scholar 

  36. Sakai T, Makita M, Akiyama F, Uehara K et al (2006) Intraductal papilloma with bloody discharge from Montgomery’s areolar tubercle examined by ductoscopy from the areola. Breast Cancer. 13(1):104–6

    Article  PubMed  Google Scholar 

  37. Bauer RL, Eckhert KH Jr, Nemoto T (1998) Ductal carcinoma in situ-associated nipple discharge: a clinical marker for locally extensive disease. Ann Surg Oncol. 5(5):452–5

    Article  CAS  PubMed  Google Scholar 

  38. Cardenosa G, Eklund GW (1991) Benign papillary neoplasms of the breast: mammographic findings. Radiology. 181:751–5

    CAS  PubMed  Google Scholar 

  39. Carter D (1977) Intraductal papillary tumors of the breast. Cancer. 39:1689–92

    Article  CAS  PubMed  Google Scholar 

  40. Ohuchi N, Abe R, Kasai M (1984) Possible cancerous change of intraductal papilloma of the breast. Cancer. 54:605–11

    Article  CAS  PubMed  Google Scholar 

  41. Hou MF, Huang TJ, Liu GC (2001) The diagnostic value of galactography in patients with nipple discharge. Clin Imaging. 25:75–81

    Article  CAS  PubMed  Google Scholar 

  42. Fung A, Rayter Z, Fisher C et al (1990), Preoperative cytology and mammography in patients with single-duct nipple discharge treated by surgery. Br J Surg. 77(11):1211–2

    Article  CAS  PubMed  Google Scholar 

  43. Teboul M (1988) A new concept in breast investigation: echo-histological acino-ductal analysis or analytic echography. Biomed Pharmacoth. 42:289–96

    CAS  Google Scholar 

  44. Feige C (1988) Dynamic morpho-cyto-echography and the echographic galactoscopy endoductal sample; intrinsic and extrinsic markers in the detection of breast cancers. Ultrasound Med and Biol. 14(1):97–108

    Article  Google Scholar 

  45. Rissanen T, Reinikainen H, Apaja-Sarkkinen M (2007) Breast sonography in localizing the cause of nipple discharge. J Ultrasound Med. 26:1031–9

    PubMed  Google Scholar 

  46. Chung SY, Lee K, Park KS, Lee Y, Bae SH (1995) Breast tumors associated with nipple discharge: correlation of findings on galactography and sonography. Clin Imaging. 9(3):165–71

    Article  Google Scholar 

  47. Cilotti A, Campassi C, Bagnlesi P et al (1996) Pathologic nipple discharge. High resolution versus conventional ultrasound in the evaluation of ductal disease. Breast Dis. 9:1–13

    Google Scholar 

  48. Ballesio L, Maggi C, Savelli S et al (2007) Adjunctive diagnostic value of ultrasonography evaluation in patients with suspected ductal breast disease. Radiol Med. 112:354–65

    Article  CAS  PubMed  Google Scholar 

  49. Sardanelli F, Imperiale A, Zandrino F et al (1997) Breast intraductal masses. Ultrasound-guided fine needle aspiration after galactography. Radiology. 204:143–8

    CAS  PubMed  Google Scholar 

  50. Govindarajulu S, Narreddy SR, Shere MH et al (2006) Sonographically guided mammotome excision of ducts in the diagnosis and management of single duct nipple discharge. EJSO. 32:725–8

    Article  CAS  PubMed  Google Scholar 

  51. Torres-Tabanera M, Alonso-Bartolome P, Vega-Bolivar A, Sanchez-Gomez SM et al (2008) Percutaneous microductectomy with directional vacuum-assisted system guided by ultrasonography for the treatment of breast discharge: experience in 63 cases. Acta Radiol. 49(3):271–6

    Article  CAS  PubMed  Google Scholar 

  52. Yoshimoto M, Kasumi F, Iwase T, Takahashi K, Tada T, Uchida Y (1997) Magnetic resonance galactography for a patient with nipple discharge. Breast Cancer Res Treat. 42:87–90

    Article  CAS  PubMed  Google Scholar 

  53. Ballesio L, Maggi C, Savelli S et al (2008) Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol med. 113: 249–64

    Article  CAS  PubMed  Google Scholar 

  54. Morrogh M, Morris E, Liberman L et al (2007) The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 14(12):3369–77

    Article  PubMed  Google Scholar 

  55. Hirose M, Nobusawa H, Gokan T (2007) MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics. 27:S183–96

    Article  Google Scholar 

  56. Hirose M, Otsuki N, Hayano D, Shinjo H, Gokan T et al (2006) Multi-volume fusion imaging of MR ductography and MR mammography for patients with nipple discharge. Magn Reson Med Sci. 5(2):105–12

    Article  PubMed  Google Scholar 

  57. Takeda T, Matsui A, Sato Y et al (1990) Nipple discharge cytology in mass screening for breast cancer. Acta Cytologica. 34(2):161–4

    CAS  PubMed  Google Scholar 

  58. Dunn JM, Lucarotti E, Wood SJ et al (1995) Exfoliative cytology in the diagnosis of breast disease. Br J Surg. 82:789–91

    Article  CAS  PubMed  Google Scholar 

  59. Florio M, Manganaro T, Pollicino A et al (1999) Surgical approach to nipple discharge: a ten-year experience. J Surg Oncol. 71:235–8

    Article  Google Scholar 

  60. Knight DC, Lowell D, Heimann A, Dunn E (1986) Aspiration of the breast and nipple discharge cytology. Surg Gynecol Obstet. 163:415–20

    CAS  PubMed  Google Scholar 

  61. Ranieri E, Virno F, D’Andrea M et al (1955) The role of cytology in differentiation of breast lesions. Anticancer Res. 15:607–12

    Google Scholar 

  62. Kawamoto M (1994) Breast cancer diagnosis by lactate dehydrogenase isoenzymes in nipple discharge. Cancer. 73:1836–41

    Article  CAS  PubMed  Google Scholar 

  63. Imayama IS, Mori M, Ueo H et al (1996) Presence of elevated carcinoembryonic antigen on absorbent disks applied to nipple area of breast cancer patients. Cancer. 78(6):12229–34

    Article  Google Scholar 

  64. Inaji H, Yayoi E, Maeura Y, Matsuura N, Tominaga S, Koyama H et al (1987) Carcinoembryonic antigen estimation in nipple discharge an adjunctive tool in the diagnosis of early breast cancer. Cancer. 60:3008–13

    Article  CAS  PubMed  Google Scholar 

  65. Nishiguchi T, Hishimoto T, Funahashi S et al (1992) Clinical usefulness of carcinoembryonic antigen measurement in nipple discharge as an adjunctive tool for diagnosis of breast cancer. Jpn J of Clin Path. 40(1):67–72

    CAS  Google Scholar 

  66. Fortova L, Garber JE, Sadowsky NL et al (1998) Carcinoembryonic antigen in breast nipple aspirate fluid. Cancer Epidemiol Biomark Prev. 7(3):195–8

    Google Scholar 

  67. Liu Y, Wang JL, Chang H et al (2000) Breast-cancer diagnosis with nipple fluid bFGF (letter). Lancet. 355(9229):567

    Article  Google Scholar 

  68. Sauter E, Shan S, Hewett J et al (2005) Proteomic analysis of nipple aspirate fluid using SELDI-TOF-MS. Int J Cancer. 114:791–6

    Article  CAS  PubMed  Google Scholar 

  69. Baker KS, Davey DD, Stelling CB (1994) Ductal abnormalities detected with galactography: frequency of adequate excisional biopsy. Am J Roentgenol. 162:821–4

    CAS  Google Scholar 

  70. Van Zee KJ, Perez GO, Minnard E, Cohen M (1998) Preoperative ductography increases the diagnostic yield of major duct excision for nipple discharge. Cancer. 82(10):1874–80

    Article  PubMed  Google Scholar 

  71. Rongione AJ, Evans BD, Kling KM, McFadden DW (1996) Ductography is a useful technique in evaluation of abnormal nipple discharge. Am Surg. 62:785–8

    CAS  PubMed  Google Scholar 

  72. Cardenosa G, Doudna C, Eklund GW (1994) Ductography of the breast: techniques and findings. Am J of Roentgenol. 162:1081–7

    CAS  Google Scholar 

  73. Saarela AO, Kiviniemi HO, Rissanen TJ (1997) Preoperative methylene blue staining of galactographically suspicious breast lesions. Int Surg. 82(4):403–5

    CAS  PubMed  Google Scholar 

  74. Hussain S, Lui DM (1997) Ultrasound-guided percutaneous galactography. Eur J Radiol. 24:163–5

    Article  CAS  PubMed  Google Scholar 

  75. Urban JA (1963) Excision of the major duct system of the breast. Cancer. 16:516–20

    Article  CAS  PubMed  Google Scholar 

  76. Srivastava A, Griwan MS, Samaiyar SS et al (1995) A safe technique of major mammary duct excision. JR Coll Edinb. 40:35–7

    CAS  Google Scholar 

  77. Jardines L (1996) Management of nipple discharge. Am Surg. 62:119–22

    CAS  PubMed  Google Scholar 

  78. Tan W, Lim TC (1992) Transareolar dye-injection microdochectomy. Am Surg. 58(7):404–8

    CAS  PubMed  Google Scholar 

  79. Sharma N, Huston T, Simmons R (2006) Intraoperative intraductal injection of methylene blue dye to assist in major duct excision. Am J Surg. 191:553–4

    Article  PubMed  Google Scholar 

  80. Matsunaga T, Ohta D, Misaka T et al (2001) Mammary ductoscopy for diagnosis and treatment of intraductal lesions of the breast. Breast Cancer. 8:213–21

    Article  CAS  PubMed  Google Scholar 

  81. Shen KW, Wu J, Lu J, Han Q, Shen Z, Nguyen M et al (2000) Fiberoptic ductoscopy for patients with nipple discharge. Cancer. 89:1512–9

    Article  CAS  PubMed  Google Scholar 

  82. Escobar PF, Crowe JP, Matsunaga T, Mokbel K (2006) The clinical applications of mammary ductoscopy. Am J Surg. 191(2):211–5

    Article  PubMed  Google Scholar 

  83. Al Sarakbi W, Salhab M, Mokbel K (2006) Does mammary ductoscopy have a role in clinical practice? Int Semin Surg Oncol. 3:16

    Article  PubMed  Google Scholar 

  84. Louie LD, Crowe JP, Dawson AE, Lee KB et al (2006) Identification of breast cancer in patients with pathologic nipple discharge: does ductoscopy predict malignancy? Am J Surg. 192:530–3

    Article  PubMed  Google Scholar 

  85. Hunerbein M, Dubowy A, Raubach M, Gebauer B, Topalidis T, Schlag P (2007) Gradient index ductoscopy and intraductal biopsy of intraductal breast lesions. Am J Surg. 194:511–4

    Article  PubMed  Google Scholar 

  86. Pereira B, Mokbel K (2005) Mammary ductoscopy: past, present, and future. Int J Clin Oncol. 10:112–6

    Article  PubMed  Google Scholar 

  87. Hunerbein M, Raubach M, Gebauer B, Wolfgang S, Schlag P (2006) Ductoscopy and intraductal vacuum-assisted biopsy in women with pathologic nipple discharge. Breast Cancer Res Treat. 99:301

    Article  PubMed  Google Scholar 

  88. Solin LJ, Recht A, Fourquet A et al (1991) Ten-year results of breast-conserving surgery and definitive irradiation for intraductal carcinoma of the breast. Cancer 68: 2337–44

    Article  CAS  PubMed  Google Scholar 

  89. Fowable BL, Solin LJ, Goodman RL (1987) Results of conservative surgery and radiation for intraductal noninvasive breast cancer. Am J Clin oncol. 10:110–1

    Google Scholar 

  90. Recht A, Danoff B, Solin LJ et al (1985) Intraductal carcinoma of the breast: results of treatment with excisional biopsy and radiation. J Clin Oncol. 3:1339–43

    CAS  PubMed  Google Scholar 

  91. Ito Y, Tamaki Y, Nakano Y et al (1997) Nonpalpable breast cancer with nipple discharge: how should it be treated? Anticancer Res. 17(1B):791–4

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Women’s Health Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk A80, Cleveland, OH, 44195, USA

    Jill R. Dietz

Authors
  1. Jill R. Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Breast Care Center National Naval Medical Center, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD, 20814, USA

    Ismail Jatoi (Head) (Head)

  2. Women’s Hospital, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Manfred Kaufmann (Breast Unit Director) (Breast Unit Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Dietz, J.R. (2010). Nipple Discharge. In: Jatoi, I., Kaufmann, M. (eds) Management of Breast Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69743-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-69743-5_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69742-8

  • Online ISBN: 978-3-540-69743-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation