Does Nipple Discharge Color Predict (pre‐) Malignant Breast Pathology?

Abstract

Unilateral single-duct nipple discharge is associated with an increased risk for underlying breast malignancy. There is no consensus whether color of nipple discharge independently indicates the risk of malignancy. We sought to assess the relationship between the color of discharge and the risk of malignancy. Patients with unilateral single-duct nipple discharge without abnormalities on clinical and radiologic examination were included. Prior to diagnostic microdochectomy nipple discharge characteristics were registered. Multiple logistic regressions were performed to assess the relationship between color of nipple discharge and malignancy, corrected for age. During a mean follow-up period of 7.1 years we determined complication rate and false-negative rate of microdochectomy. A total of 184 patients were included (median age 53 years, range 19-84). Histologic examination revealed (in situ or invasive) breast carcinoma in 10.9% (20) of patients and high-risk lesions in 11.4% (21). Malignancy or high-risk lesions were found in 25% (OR: 1.37; 95% CI: 0.62-3.00) of patients with bloody discharge. Risk of underlying malignancy increased in patients >60 years (OR: 2.35; 95% CI: 1.14-4.83). Complication rate of microdochectomy was 2.7%. Single-duct, unilateral nipple discharge is a sign of underlying malignancy in a substantial proportion of cases. The majority of patients with unilateral single-duct nipple discharge, diagnosed with breast cancer, present with bloody discharge. However, the association between bloody nipple discharge and malignancy is not strong enough to distinguish high-risk patients. Therefore, invasive diagnostic procedures like microdochectomy should be offered to all patients with unilateral uniductal nipple discharge to search for underlying malignancy.

A Second Ductoscopy Procedure in Patients with Recurrent and Persistent Pathological Nipple Discharge

“…One patient was diagnosed with DCIS after surgery, leading to a malignancy rate in the study population of 5.9%. This is in line with previous studies in which the malignancy rate in patients with PND without radiological suspicion for malignancy was between 5 and 10% [7][8][9][10]. This means that the vast majority of the patients who suffered from PND were operated on because of a benign lesion.…”

“…The most common causes of PND are benign, namely, an intraductal papilloma and duct ectasia [6][7][8]. In around 5-10% of the patients suffering from PND without radiological abnormalities, the cause of nipple discharge is an underlying malignancy (ductal carcinoma in situ [DCIS] or invasive carcinoma) [7][8][9][10].…”

Role of duct excision surgery in the treatment of pathological nipple discharge and detection of breast carcinoma: systematic review

“… 29 reported no breast cancer development during a follow-up of 3–9 years (zero of 66 patients) and Wong Chung et al . 35 reported three patients with breast cancer during a follow-up interval of 3–12 years (three of 184 patients; 1.6 per cent). These three patients had primary benign histology after surgery and developed a tumour in the ipsilateral breast, but at different locations.…”

“…These three patients had primary benign histology after surgery and developed a tumour in the ipsilateral breast, but at different locations. Those malignancies were considered as new and not related to the initial duct excision surgery 35 .…”

“…Furthermore, the included studies poorly described breast cancer development in patients after duct excision surgery. One study reported no breast cancer development during a follow-up of 3–9 years 29 and, in one study, three patients developed breast cancer during a follow-up of 3–12 years 35 . These three patients had a tumour in the ipsilateral breast, but at different locations and after such a time interval that Wong Chung et al .…”