Pathologic Nipple Discharge

  • Pathologic nipple discharge:
    • Is characteristically spontaneous, unilateral, uniductal, or bloody
  • Physiologic discharge is:
    • Nonspontaneous, bilateral, multiductal, and milk
  • The most common causes for pathologic nipple discharge are benign:
    • Intraductal papillomas
    • Duct ectasia)
  • The presence of abnormal clinical findings on imaging or physical exam:
    • Is associated with increased risk of malignancy:
      • 38% vs. 2%
  • Contemporary workup for nipple discharge includes:
    • Mammography and evaluation of the retroareolar region with ultrasound
    • Patients with normal findings on mammography, ultrasound, and physical exam can be further evaluated with breast MRI:
      • As it is highly sensitive and specific for cancer
  • Surgical management of nipple discharge includes:
    • Excision of a single duct or central duct apparatus:
      • Depending on the number of ducts involved
  • References
  • Li GZ, Wong SM, Lester S, Nakhlis F. Evaluating the risk of underlying malignancy in patients with pathologic nipple discharge. Breast J. 2018;24(4):624-627.
  • de Paula IB, Campos AM. Breast imaging in patients with nipple discharge. Radiol. Bras. 2017;50(6):383-388.
  • Yilmaz R, Bender O, Celik Yabul F, Dursun M, Tunaci M, Acunas G. Diagnosis of nipple discharge: value of magnetic resonance imaging and ultrasonography in comparison with ductoscopy. Balkan Med J. 2017;34(2):119-126.

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #Miami #CASO #CenterforAdvancedSurgicalOncology

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