Clinical Evaluation of Nipple Discharge

ABSTRACT

PURPOSE: Nipple discharge is a disturbing symptom due to the fear of breast cancer, although approximately 95% of incidents of nipple discharge arise from benign causes. This study was designed to determine a proper approach for referrals with nipple discharge. METHODS: One hundred and ten patients who underwent surgery due to nipple discharge were included in the study. Clinical parameters, including age, characteristics of nipple discharge, clinical breast examination findings, mammographic findings and ultrasonographic findings were analyzed in association with the pathologic diagnosis of malignancy. A chi-square test and logistic regression test were used to assess the statistical significance of the results. RESULTS: The mean age of the patients was 44.8 year-old (range 19-84). The most common cause diagnosed was intraductal papilloma of 58 (52.7%), followed by 18 fibrocystic changes (16.4%), 17 infiltrating ducal carcinomas (15.5%), 14 intraductal carcinomas (12.7%) and 3 duct ectasias (2.7%). The number of incidences of malignancy was 31 (28.2%). Bloody nipple discharge, nipple discharge with accompanying mass, abnormal mammographic finding and abnormal ultrasound finding were associated with malignancy in 43.2%, 55.6%, 50% and 66.7%, respectively, as compared with 11.5% in serous discharge, 22.6% in discharge without accompanying mass, 21.9% in normal mammographic finding and 52.9% in normal ultrasonographic finding, respectively. In a multivariate analysis of factors predicting malignancy, nipple discharge with accompanying mass and bloody nipple discharge were the independent risk factors. CONCLUSION: Triple examinations including physical examination, mammogram and ultramammography would be necessary for the complete evaluation of nipple discharge and surgical excision is mandatory in cases with suspicion of cancer.