Author(s): Sala Abdalla, Louis Savage, Yazan Masannat, Sarah E. Pinder, Ian S Fentiman, and Hisham Hamed
Introduction: Pathological nipple discharge is usually of benign aetiology but cancer may be the underlying cause in up to 20% of the presentations. The diagnostic value of discharge cytology and significance of presence of blood remains a topic of interest. Our study sets out to review the distribution of histopathology and diagnostic application of blood-staining and cytology in pathological nipple discharge. Methods: We performed a retrospective analysis of those patients that had surgery for pathological nipple discharge. The hospital’s electronic medical records and breast cancer information systems were used to identify our study cohort. Parameters evaluated included patient demographics, radiological assessment, if discharge was blood-stained and histological/cytological analysis. Results: Of 123 patients, intraductal papilloma was the leading diagnosis (𝑛 = 62) followed by duct ectasia (𝑛 = 34). Carcinoma in-situ and invasive carcinoma occurred in nine cases. Seventy-one patients presented with blood-stained nipple discharge of which 41 had a diagnosis of intraductal papilloma, 17 had duct ectasia, and seven cases were due to carcinoma. Two cases of cancer were negative for blood. Cytology was done only in 23 patients and was not diagnostic of carcinoma and identified intraductal papilloma in only 3 cases. Conclusion: This study supports the generally accepted view that cytology has very poor sensitivity for detecting breast cancer and has therefore very limited diagnostic value. Nipple discharge that is negative for blood is still associated with cancer. It also confirms that intraductal papilloma is the leading cause of pathological nipple discharge.
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