Lessons learned from 416 cases of nipple discharge of the breast Journal Article
| Authors: | Morrogh, M.; Park, A.; Elkin, E. B.; King, T. A. |
| Article Title: | Lessons learned from 416 cases of nipple discharge of the breast |
| Abstract: | Background: For patients with nipple discharge (ND), surgical duct excision is often required to exclude underlying malignancy. Our objective was to define clinical predictors of malignancy and examine the utility of common preoperative studies. Study design: We retrospectively identified 475 patients presenting with a chief complaint of ND from 1995 to 2005; 416 (88%) were eligible for review. Results: Following standard evaluation (clinical breast examiation/mammogram/ultrasound), 129 of 416 (31%) were considered to have physiological ND and were managed expectantly, whereas 287 of 416 (69%) underwent further evaluation (cytology/ductography/magnetic resonance imaging) followed by biopsy ± surgery. Clinical features associated with pathological ND included bloody ND (adjusted odds ratio 3.7) and spontaneous ND (adjusted OR 3.2). Biopsy/surgery identified a causative lesion in 259 of 287 (90%), of which 37% were either malignant (n = 65) or high-risk (n = 30) lesions. The sole clinical predictor of malignant/high-risk lesion was a palpable mass (adjusted odds ratio 4.3). Preoperative evaluation identified 76 of 95 (80%) malignant/high-risk lesions, whereas 19 of 95 (20%) were identified by duct excision alone. Conclusions: Although clinical stratification alone reliably identified patients with pathological ND, neither the clinical characteristics nor preoperative studies can reliably distinguish between benign and malignant pathology. Surgical duct excision remains the gold standard to exclude underlying malignancy. © 2010 Elsevier Inc. |
| Keywords: | adult; controlled study; aged; aged, 80 and over; middle aged; excision; retrospective studies; young adult; major clinical study; clinical feature; nuclear magnetic resonance imaging; preoperative evaluation; cytology; cohort studies; breast cancer; mastectomy; breast neoplasms; medical record review; retrospective study; breast imaging; mammography; breast examination; echography; clinical evaluation; carcinoma; predictive value of tests; predictor variable; nipples; breast surgery; breast biopsy; nipple discharge; breast discharge; duct excision; nipple aspirate fluid |
| Journal Title: | American Journal of Surgery |
| Volume: | 200 |
| Issue: | 1 |
| ISSN: | 0002-9610 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2010-07-01 |
| Start Page: | 73 |
| End Page: | 80 |
| Language: | English |
| DOI: | 10.1016/j.amjsurg.2009.06.021 |
| PUBMED: | 20079481 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: AJSUA" - "Source: Scopus" |
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