Management of bloody nipple discharge
Bloody nipple discharge causes a high degree of anxiety in women because of fear of breast cancer. Commonly, the absence of palpable or mammographic abnormalities gives a false sense of security, causing delays in diagnosis. Initial evaluation with physical examination and mammography is useful in detecting high-risk cases. Bloody nipple discharge is most frequently benign. It is caused by intraductal papilloma, duct ectasia, and less frequently by breast cancer. Several diagnostic tests have been proposed to establish the cause of bloody nipple discharge. Galactography, ultrasound, and exfoliative cytology are useful only when positive, but have a high rate of false-negative results and do not preclude histologic diagnosis. More recently, ductal lavages in combination with cytology have provided promising results, but experience and long-term follow-up are limited. Traditional treatment is surgical excision of the involved ductal system from which the discharge emanates. Ductal excision has been the only reliable procedure in establishing a certain diagnosis and in controlling the bloody discharge. The early success reported with image-guided excision of papilloma and duct endoscopy promises a significant improvement in our diagnostic accuracy from minimally invasive emerging technology.
KeywordsNipple Discharge Ductal Lavage Intraductal Papilloma Inverted Nipple Exfoliative Cytology
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References and Recommended Reading
- 1.Goodson WH III, King EB: Discharges and secretions of the nipple. In The Breast: Comprehensive Management of Benign and Malignant Diseases. Edited by Bland KI, Copeland EM III. Philadelphia: WB Saunders; 1998:51–75.Google Scholar
- 2.Winchester D: Nipple discharge. In Diseases of the Breast. Edited by Harris JR, Lippman ME, Morrow M, Hellman S. Philadelphia: Lippincott-Raven; 1996:106–110.Google Scholar
- 3.Urban J, Egeli R: Non-lactational nipple discharge. CA Cancer J Clin 1978, 28:3.Google Scholar
- 4.Leis H, Dursi J, Mersheimer WL: Nipple discharge: significance and treatment. NY State J Med 1967, 67:3105.Google Scholar
- 5.Murad T, Contesso G, Mouriesse H: Nipple discharge from the breast. Ann Surg 1982:195.Google Scholar
- 16.Baker KS, Davey DD, Stelling CB: Ductal abnormalities detected with galactography: frequency of adequate excisional biopsy. Am J Roentgenol 1994, 162:821–824.Google Scholar
- 17.Cardenosa G, Doudna C, Eklund G: Ductography of the breast: technique and findings. Am J Roetgenol 1994, 162:1081–1087.Google Scholar
- 18.Danforth D, Lichter A, Lippman M: The diagnosis of breast cancer. In Diagnosis and Management of Breast Cancer. Edited by Lippman M, Lichter A, Danforth D. Philadelphia: WB Saunders; 1988:50–94.Google Scholar