Implications of nipple discharge in Hong Kong Chinese women

Abstract

Introduction:There are no recent data on nipple discharge and its association with malignancy in Hong Kong Chinese women. This study reported our 5-year experience in the management of patients with nipple discharge, and our experience of mammography, ultrasonography, ductography, and nipple discharge cytology in an attempt to determine their role in the management of nipple discharge. Methods:Women who attended our Breast Clinic in a university-affiliated hospital in Hong Kong were identified by retrospective review of clinical data from January 2007 to December 2011. They were divided into benign and malignant subgroups. Background clinical variables and investigative results were compared between the two subgroups. We also reported the sensitivity, specificity, and positive and negative predictive values of the investigations that included mammography, ultrasonography, ductography, and cytology. Results:We identified 71 and 31 patients in the benign and malignant subgroups, respectively. The median age at presentation for the benign subgroup was younger than that of the malignant subgroup (48 vs 59 years; P=0.003). A higher proportion of patients in the malignant subgroup than the benign subgroup presented with bloodstained nipple discharge (87.1% vs 47.9%; P=0.002). Mammography had a specificity of 98.4% and Implications of nipple discharge in Hong KongChinese women

Clinical Significance of Pathological Nipple Discharge as a Single Breast Symptom: A Single-institute Experience

“…In the current study; in addition to age and abnormal imaging; the bloody unilateral uniductal induced discharge with suspicious pathology are red flags of malignancy. In our study; 75% of cancer patients had bloody discharge which is similar to the several studies and meta-analyses which concluded that bloody nipple discharge is found to be associated with underlying malignancy [20][21][22] while in one study conducted with Røpcke., et al [18] who did not find a significant association between bloody discharge and invasive cancer. This difference may be due to the low number of cases included in each study as well as the difference in selection criteria [18].…”

Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature

“…Overall, these specificity and sensitivity data are echoed across individual studies of patients presenting with symptomatic nipple discharge. 16 , 17 Interestingly, the diagnostic accuracy of nipple cytologic analysis of patients with PND is similar to that of other diagnostic tests, with sensitivities ranging from a high of 70 % for both ultrasound and MRI to a specificity high of 79 % for mammography. Critically, in the case of a patient whose sole symptom is nipple discharge, no individual diagnostic test, whether imaging or cytologic, yielded a sensitivity or specificity high enough for its use as a stand-alone test.…”

Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

“…59 The primary finding of this meta-analysis is that the sensitivity of NAF cytology for cancer detection in asymptomatic women is poor [0.64 (95% CI 0.62-0.66)] and yet the specificity is extremely high [0.97 (95% CI 0.97-0.98)]. Overall, high specificity and low sensitivity data is echoed across individual studies and also in those presenting with symptomatic nipple discharge, 60,61 with a diagnostic accuracy for malignancy of only 31%. 60 The reason for such low sensitivity of nipple aspirate fluid is that discharge is often ''physiological'' in nature, has a generally high acellular or paucicellular composition, 58,62,63 and therefore is thought to consist almost exclusively of background debris and/or proteinaceous material.…”