ABSTRACT
Nipple discharge causes a 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. Mammography, ultrasound, and cytology are useful only when positive, but have a high rate of false-negative results and do not preclude histological diagnosis. The aim of this study is to detect incidence of malignancy in Egyptian women presenting with nipple discharge and protocol for their management. Forty patients with pathological nipple discharge were included in the study and offered operation. Patients with surgically significant nipple discharge only of 40 years and above are recommended to undergo radical subareolar duct excision [Hadfield's procedure]. Patients below 40 years of age, particularly if intending to breast feed, with persistent discharge are given the option of microdochectomy. All histopathology results were reviewed. Patients were divided into two groups - those with red blood cells [RBCs] present in the nipple discharge and those without. Forty consecutive patients underwent operation for isolated nipple discharge during the study period. Median age was 54 years [range, 32-79 years]: Analysis of nipple discharge revealed RBCs in 16 patients [40%]. The remainder, 24[60%], had no RBCs on analysis of nipple discharge. Thirty seven patients [92.5%] underwent radical subareolar duct excision [Hadfield's procedure] and 3 patients [7.5%] microdochectomy. Histopathology revealed all patients with RBCs -positive nipple discharge had benign disease -7 [43.75%] had an intraductal papilloma and 9 [56.25%] had duct ectasia. Most patients with RBCs negative nipple discharge had benign disease - 4 [16.6%] had intraductal papilloma and 18 [75%] duct ectasia while the remaining two [8.33%] had in situ carcinoma. Despite the various tests used in the assessment of pathological nipple discharge, this study highlights their limited help at predicting the cause. This, together with several other studies, demonstrates that ductal surgery remains the only reliable way of providing a diagnosis, in addition to being the ideal therapeutic measure