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Is microductectomy still necessary to diagnose breast cancer: a 10-year study on the effectiveness of duct excision and galactography

  • Daniel Ben Lustig
  • Rebecca Warburton
  • Carol K. Dingee
  • Urve Kuusk
  • Jin-Si Pao
  • Elaine C. McKevitt
Clinical trial
  • 48 Downloads

Abstract

Purpose

Patients with spontaneous nipple discharge (SND) who have neither clinically palpable masses nor evidence of disease on imaging with mammogram and/or ultrasound are traditionally investigated with galactogram and duct excision. As breast imaging improves, it has raised the question whether galactography and microductectomy are necessary to diagnose breast cancer. The purpose of this study was to determine the incidence of malignancy in patients presenting with SND who underwent microductectomy and to evaluate the utility of duct excision and galactography in patients whose initial clinical and radiological evaluation were negative.

Methods

A 10-year retrospective study was conducted in British Columbia’s largest tertiary breast referral center examining the clinical, radiological and pathological results for all patients who underwent a microductectomy procedure for SND between 2008 and 2017.

Results

A total of 231 microductectomies were performed and the overall incidence of malignancy was 13% (n = 32). Following initial work up, 155 patients (67%) had only discharge on exam and no radiologically suspicious findings of malignant disease. Of these patients, 14% (n = 21) were diagnosed with cancer by duct excision. Galactography yielded a sensitivity and specificity of 63% and 36%, respectively (PPV 15% and NPV 85%). Lastly, we found that 3% of patients (n = 8) initially diagnosed with benign disease later developed breast cancer.

Conclusions

Patients with SND should continue to be evaluated with microductectomy to prevent missing a breast cancer. Moreover, we do not recommend performing galactography for diagnosing breast cancer due to poor sensitivity and specificity though it may assist in preoperative planning.

Keywords

Nipple discharge Breast cancer Microductectomy Galactogram Duct excision Breast imaging 

Notes

Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest to declare for this publication.

Ethical approval

This study was approved by the Research Ethics Board by the University of British Columbia and Providence Health Care. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Mansel RE, Webster D, Sweetl HM (2009) Hughes, Mansel & Webster’s benign disorders and diseases of the breast. Saunders Ltd, LondonGoogle Scholar
  2. 2.
    Van Zee K, Ortega P, Minnard E, Cohen M (1998) Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge. Cancer 82:1874–1880CrossRefGoogle Scholar
  3. 3.
    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 14:3369–3377CrossRefGoogle Scholar
  4. 4.
    Berger N, Luparia A, Di Leo G, Carbonaro L et al (2017) Diagnostic performa athologic nipple discharge: a systematic review and meta-analysis. Am J Roentgenol 209(2):465–471CrossRefGoogle Scholar
  5. 5.
    Patel B, Falcon S, Drukteinis J (2015) Management of nipple discharge and the associated imaging findings. Am J Med 128:353–360CrossRefGoogle Scholar
  6. 6.
    Foulkes R, Heard G, Boyce T, Skyrme R et al (2011) Duct Excision is still necessary to rule out breast cancer in patients presenting with spontaneous bloodstained nipple discharge. Int J Breast Cancer 495315–495321Google Scholar
  7. 7.
    Lanitis S, Filippakis G, Thomas J, Christofides T et al (2008) Microdochectomy for single-duct pathological nipple discharge and normal or benign imaging and cytology. Breast 17:309–313CrossRefGoogle Scholar
  8. 8.
    Gray R, Pockaj B, Karstaedt P (2007) Navigating murky waters: modern treatment algorithm for nipple discharge. Am J Surg 194:850–854CrossRefGoogle Scholar
  9. 9.
    Sable M, Helvie M, Breslin T et al (2012) Is duct excision still necessary for all cases of suspicious nipple discharge? Breast J 18:157–162CrossRefGoogle Scholar
  10. 10.
    Onstad M, Stuckey A (2013) Benign breast disorders. Obstet Gynecol Clin North Am 40:459CrossRefGoogle Scholar
  11. 11.
    Li G, Wong S, Lester S, Nakhlis F (2018) Evaluating the risk of underlying malignancy in patients with pathologic nipple discharge. Breast J 24:624–627CrossRefGoogle Scholar
  12. 12.
    Lubina N, Schedelbeck U, Roth A et al (2015) 3.0 T breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail. Eur Radiol 25:1285–1293CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryVancouver Coastal HealthVancouverCanada
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.Providence Breast CenterMount Saint Joseph HospitalVancouverCanada

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