The role of nipple discharge cytology in the diagnosis of breast disease: a study of 1948 nipple discharge smears from 1530 patients

Abstract

In this study a review of 1948 nipple discharge (ND) samples from 1530 patients in the age range of 18-83 years was undertaken to determine whether cytological findings from ND smears could provide useful diagnostic information regarding various breast lesions. The study included 1494 females and 36 males and was carried out during a period of 20 years 8 months. The clinical information in all patients was obtained from clinicians (coauthors), medical records and a review of biopsies in 205 patients who had undergone surgery following the cytodiagnosis. Of the ND samples examined, 1480 were unilateral while 468 were from 234 bilateral ND. The cytodiagnoses were: benign 624, inadequate (despite two to three repeat samples) 492, inflammatory 96, papillary lesion not otherwise specified (NOS) 229, suspicious 22 (21 females, one male) and malignant 67 (63 females, four males). A breast biopsy in the 22 suspicious cases revealed breast carcinoma in 18 cases (females n = 17, male n = 1), atypical ductal hyperplasia (female n = 1), fibroadenoma (female n = 1) and a papilloma in two females. In the 67 cases with a diagnosis of malignancy 65 revealed a breast carcinoma in the biopsy (female n = 62, male n = 3) while one female was diagnosed as fibroadenoma and one male as florid gynaecomastia. In 63 cases (females n = 61; males n = 2) with clinical lumpy areas consistent with the diagnosis of fibrocystic condition in ND, the biopsy confirmed a fibrocystic process. In 53 of 229 cases with ND findings suggestive of a papillary lesion (NOS) the biopsy revealed a papilloma in 41 cases while in 12 cases no lesion was found. In the remaining cases of all the groups only a clinical follow-up and appropriate investigations were performed with no untoward outcome. Based on our study it is felt that cytological examination of ND smears seems to be a reasonably specific method in the diagnosis of malignant and suspicious cases but may be somewhat less specific for other diagnoses.

Nipple discharge cytology: do we swim against the tide?

“…İlaçlar, hipertiroidizm ve hipotiroidizm, yüksek prolaktin seviyeli hipofiz adenomu, gebelik ya da laktasyon gibi hormonal değişiklikler en sık sebepleridir (3). Patolojik MBA ise tipik olarak spontan, tek taraflı, tek duktusu tutan, seröz ya da kanlı akıntı şeklindedir (4).…”

Suspicious Nipple Discharge Diagnostic Evaluation

“…Gupta et al (2004) have suggested that the use of routine ND cytology is limited by the small samples obtained and that ND cytology cannot always distinguish between physiological processes, fibrocystic disease, and papillomas. However, studies based on a large number of cases suggest that ND cytology is a reasonable method for diagnosing malignant and suspicious cases (Das et al, 2001;El-Daly & Gudi, 2010;Gupta et al, 2004;Pritt et al, 2004). Cytological examination of ND is valuable mainly for detecting such cancers.…”

“…However, ND samples are often inadequate. Gupta et al (2004) showed that 492 of 1948 ND smears (25%) were inadequate for diagnosis. Lee (2003) reported that ND cytology was non-diagnostic in 43 of 82 cases (52%), whereas FNA cytology was non-diagnostic in only 1 of 34 cases (2.9%).…”

“…Breast www.intechopen.com pumping, breast massage, or nipple aspiration may be attempted if the discharge does not occur spontaneously during collection of the samples (Gupta et al, 2004;Krishnamurthy, et al, 2003). Gupta et al (2004) have suggested that the use of routine ND cytology is limited by the small samples obtained and that ND cytology cannot always distinguish between physiological processes, fibrocystic disease, and papillomas.…”

“…Breast www.intechopen.com pumping, breast massage, or nipple aspiration may be attempted if the discharge does not occur spontaneously during collection of the samples (Gupta et al, 2004;Krishnamurthy, et al, 2003). Gupta et al (2004) have suggested that the use of routine ND cytology is limited by the small samples obtained and that ND cytology cannot always distinguish between physiological processes, fibrocystic disease, and papillomas. However, studies based on a large number of cases suggest that ND cytology is a reasonable method for diagnosing malignant and suspicious cases (Das et al, 2001;El-Daly & Gudi, 2010;Gupta et al, 2004;Pritt et al, 2004).…”