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Evaluation and management of pathological nipple discharges without using intraductal imaging methods

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Abstract

Background

The most common cause of pathological nipple discharge (PND) is single papilloma, which is a benign intraductal lesion (BIL). However, underlying malign (MIL) or high-risk intraductal lesions (HIL) should be considered during examination.

Aim

To reveal the value of conventional imaging methods (CIM), discharge characteristics, and cytology in lack of intraductal imaging methods to detect intraductal lesions (IL) and MIL that cause PND.

Methods

We compared the pathological findings with the characteristics of discharge, CIM, and cytology findings of the patients who admitted to our clinic with nipple discharge and underwent duct excision (n = 111).

Results

IL were detected in 69 (62.2%) patients as BIL (n = 31), HIL (n = 23), and MIL (n = 15). Most of the IL was observed with bloody, serosanguineous, and serous discharges (83.3%, 76.2%, and 69.2%, respectively). The sensitivities of ultrasonography, MRI, and cytology in detecting IL were found to be 50.7%, 42.6%, and 74.1%, while their specificities were found to be 73.8%, 88.2%, and 48.6%, respectively. None of the CIM was sufficient to detect MIL in 5 (33.3%) patients. The appearance of red blood cells detailed in cytology was significantly related to IL (p < 0.01), whereas the presence of inflammatory cells was related to ductal ectasia and periductal mastitis (p < 0.001).

Conclusions

Although patients’ physical examinations, CIM, and cytology findings were normal, duct excision procedures should be applied to exclude MIL or HIL, which can be a cause of discharge in case of suspicious color. The details in cytology reports have a role in increasing the value of cytology.

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Authors and Affiliations

  1. Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey

    Kenan Çetin & Hasan Ediz Sıkar

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  1. Kenan Çetin
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  2. Hasan Ediz Sıkar
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Correspondence to Kenan Çetin.

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The authors declare that they have no conflict of interest.

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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. The study protocol was approved by Dr. Lutfi Kirdar Kartal Research and Training Hospital in affiliation with the University of Health Sciences’ ethics committee.

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Çetin, K., Sıkar, H.E. Evaluation and management of pathological nipple discharges without using intraductal imaging methods. Ir J Med Sci 189, 451–460 (2020). https://doi.org/10.1007/s11845-019-02107-3

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  • DOI: https://doi.org/10.1007/s11845-019-02107-3

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