S FOR TSTIGATION AND MANAGNT OF SPONTAN STIGATIONSRadiologyMammogramultrasoundflowdiagramDiagram1MRImayconsideredselectedofegpersistentbloodydischargestrongfamily history but normal routine rad ID: 938280
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BACKGROUNDNipple discharge in the absence of a palpable breast mass:Accounts for up to 5% of referrals to breast surgical servicesIs a poor indicator of an underlying malignancy (incidence of occult malignancy around 3%)Benign papilloma is the commonest mass lesion associated with nipple dischargeHISTORY & EXAMINATIONBilateral multiduct dischargeIn women of child bearing age most likely cause is: Benign physiological secretions (whitish discharge) orPeriductal mastitis / duct ectasia (green/dark/black discharge) (especially in cigarette smokers)In postmenopausal women most likely cause is: Duct ectasiaSingle duct dischargeOf any colour/ type at any age requires careful assessmentGalactorrhoea due to hyperprolactoneamia• Iscommonlyrelated S FOR TSTIGATION AND MANAGNT OF SPONTAN STIGATIONSRadiologyMammogramultrasoundflowdiagram(Diagram1)MRImayconsideredselectedof(e.g.persistentbloodydischarge,strongfamily history) but normal routine radiologyNipple cytology (NC)Ther
e is very wide variation in reported accuracy of NC but it has a high false positive rate papillary lesions or (e.g.133-17%4,toThe specificity is higher than the sensitivity but NC is a poor predictor of histological diagnosisNC is not recommended in the assessment of patients with nipple discharge4,ANAGDiagram Clinical Practice & Standards Committee of the Association of Breast Surgeryroduced:January 2019Themanagementofbreastproblemspregnancylactation.Scott-ConnerSurg.Oct;170(4):401-5.DiagnosticUtilityofMRIAfterNegativeInconclusiveMammographyforEvaluationofPathologicNippleDischarge.BahlLehmanCD.Roentgenol209(6):1404-1410Cytology of spontaneous nipple discharge-is it worth it? Performance of nipple discharge preparations in the CollegeofPathologistsInterlaboratoryComparisonProgramNongynecologicCytopathology.MoriartyAT,SchwartzMR,BoothAugerThomasArchPatholMed.137(8):1039-42.4. Thevalueofnippledischargecytology618consecutivepatients.KooistraBW,WautersvanVenStrobbeEurS
urgOncol.Jun;35(6):573-7.The diagnostic value of nipple discharge cytology: breast imaging complements predictive value of nipple dischargecytology.ChowWheelerKongWapnirSurgOncol.202;106(4):381-5.NonsurgicalevaluationofpathologicnippledischargeSimmonsAdamovichT,BrennanChristosP,SchultzOsborneSurgOncol.continued...SUMMARYSTAT SUMMARYSTAT ipple ischarge reassure patientoffer smoking advice discharge risk of very profuse amounts of discharge (eg stains through clothes) observation onlyconsider microdochectomy or total duct excision if clear or blood stained discharge surgery can be considered in non smokers imaging not indicated exclude pregnancy over reassure and reassess2 mths post partum MDT M1 M1mammogram MDT mammography subareolar ultrasound (all ages) plus mammographyfor ultiple ingle yesyesyesyesyesiagram 1: ABSAlgorithmforAssessmentManagementofWomanNippleDischargeAbsenceofPalpableBreastLumpAshfaqValidationoftreatmentfornippledischarge.Surgery2014,222-2