Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge

Cabioglu, Neslihan; Hunt, Kelly K; Singletary, S.Eva; Stephens, Tanya W; Marcy, Sylvie; Meric, Funda; Ross, Merrick I; Babiera, Gildy V; Ames, Frederick C; Kuerer, Henry M

doi:10.1016/S1072-7515(02)01606-X

« Previous Next »Journal of the American College of Surgeons
Volume 196, Issue 3 , Pages 354-364, March 2003

Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge☆

Neslihan Cabioglu, MD, PhD
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Kelly K Hunt, MD, FACS
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
S.Eva Singletary, MD, FACS
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Tanya W Stephens, MD
- Department of Radiology (Stephens), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Sylvie Marcy, RN
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Funda Meric, MD
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Merrick I Ross, MD, FACS
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Gildy V Babiera, MD
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Frederick C Ames, MD, FACS
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Henry M Kuerer, MD, PhD
- Department of Surgical Oncology (Cabioglu, Hunt, Singletary, Marcy, Meric, Ross, Babiera, Ames, Kuerer), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Correspondence address: Henry M Kuerer, MD, PhD, Department of Surgical Oncology, Box 444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030, USA.

Received 23 April 2002; received in revised form 31 July 2002; accepted 11 September 2002.

Abstract

Background

There is no consensus about the use of the various diagnostic tests and surgical procedures available to confirm or rule out breast cancer in patients presenting with nipple discharge. This study was designed to identify patient and nipple-discharge characteristics associated with the diagnosis of breast cancer and to determine the utility of mammography, sonography, ductography, and cytology in surgical decision making in patients presenting with pathologic nipple discharge.

Study design

We reviewed the medical records of all patients who presented with nipple discharge at our institution between August 1993 and September 2000. Patient and nipple-discharge characteristics and findings on imaging studies and cytologic examination were analyzed.

Results

A total of 146 patients presented at our institution with nipple discharge during the study period. Of these, 52 had clinically benign discharge and were managed without surgical intervention; 94 patients had pathologic discharge and underwent a biopsy procedure for histologic diagnosis, treatment, or both. Logistic regression analysis identified mammographic (relative risk [RR] = 10.47, 95% confidence interval [CI] 2.36 to 46.39, p = 0.0002) and sonographic (RR = 5.54, 95% CI 1.27 to 25.40, p = 0.028) abnormalities as independent factors associated with a malignant diagnosis. Nineteen cancers, 62 papillomas, and 13 other benign lesions were identified among the patients with pathologic discharge. In 3 patients with cancer (15.8%) and 30 patients with a papilloma (48.4%), ductography was the only means of identifying lesions to be resected. Patients who underwent ductography-guided operation (n = 42, 50%) or any surgical procedure including a localization study (n = 66, 78.6%) were significantly more likely than patients who underwent central duct excision alone to have a specific underlying lesion identified (p = 0.045 and p = 0.033, respectively).

Conclusions

Abnormalities on mammography and sonography in patients with nipple discharge should alert physicians to the possibility of a breast cancer diagnosis. In patients with pathologic discharge with normal findings on physical examination and other imaging studies, ductography might be the only means of localizing and resecting breast lesions associated with nipple discharge.