Nipple discharge: Follow-up in operated versus non-operated patients - A single center experience

Abstract

Introduction: Patients with nipple discharge are often treated surgically and pose a diagnostic and therapeutic challenge. The objective of the present study was to investigate if clinical predictors of underlying malignancy could be identified. Material and methods:We retrospectively identified 400 patients with nipple discharge as primary complaint at referral in our institution from 2007 to 2015. Two hundred patients were surgically treated, and two hundred were observed. Patient charts, national health registries, radiology findings and pathology findings were evaluated. The two groups were compared, and the patients with invasive cancer / carcinoma in situ (CIS) was characterized.Results: In the operated group, patients were significantly older, and more patients had bloody discharge (p < 0.001). In the operated group, invasive cancer was found in 2%, and CIS was found in 9% of cases. No radiologic finding had indicated this preoperatively. Recurrent bloody nipple discharge was seen more frequently in the invasive cancer group. During follow-up, one case of invasive cancer emerged in each group. A history of previous breast cancer significantly increased the risk of an underlying invasive cancer in nipple discharge patients (p < 0.05). Conclusion:Current clinical stratification identifies patients with pathological nipple discharge requiring surgery, but over-treatment is a concern. According to existing literature, and partially supported by the current study findings, all women aged 50 years or more presenting with recurrent, bloody nipple discharge should be offered duct excision, which remains the diagnostic gold standard, especially in case of a medical history with previous breast cancer.