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Conservative management of non-bloody nipple discharge
Traditionally, it is believed that
up to 10-20% of pathological breast discharge is associated with breast
carcinoma. As a result of this numerous women with breast discharge
undergo exploratory surgery to rule out serious pathology. In recent years
however, there has been a considerable improvement in preoperative
diagnosis of breast cancer. We hypothesised that those with no obvious
carcinoma, undergoing microdochectomy or major duct excision for nipple
discharge would have a low rate of carcinoma on excision. In this study, we assessed 211
consecutive patients over a 14-year period (1991-2005) who had a major
duct excision for the evaluation of nipple discharge.
Of these, 116 patients had pathological (unilateral, uniductal
serous or bloody) discharge. On excision, 6% of patients with pathological
discharge and 2.4% of patients with non-pathological discharge were
diagnosed with carcinoma. Overall,
major duct excision resulted in the diagnosis of carcinoma in 4.3%, ADH/LCIS
in 4%, papilloma in 39%, and duct ectasia or non-specific benign disease
in 53% of patients. None of the 59 patients with non-bloody discharge were
found to have carcinoma upon excision. These results demonstrate that microdochectomy or major duct excision performed for evaluation of nipple discharge resulted in a low rate of malignancy on excision. Patients with non-bloody nipple discharge were at particularly low risk, and could potentially be managed conservatively.
Bibliographical reference:
Mary Dillon Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
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