Pathologic Nipple Discharge

  • Pathologic nipple discharge:
    • Is characteristically spontaneous, unilateral, uni-ductal or bloody
  • Physiologic discharge:
    • Is nonspontaneous, bilateral, and milky
  • The most common causes for pathologic nipple discharge are:
    • Benign:
      • Intraductal papillomas
      • Duct ectasia
  • In a patient with a pathologic nipple discharge:
    • And 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
    • 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
  • A patient with abnormalities in the physical exam and in imaging (ultrasound or mammography:
    • Would need surgical intervention even with a negative breast MRI
  • 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 #BreastSurgeon #CancerSurgeon #SurgicalOncologist #Miami #Mexico #MountSinaiMedicalCenter #MSMC #BloodyNippleDischarge #NippleDischarge #BreastCancer

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