MANAGEMENT OF NIPPLE DISCHARGE

In a series of 9,312 women who consulted one of the authors with a com plaint of disease of the breast between 1959 and 1991, nipple discharg e was the presenting symptom in 448 (4.8 percent). Nipple discharge wa s spontaneous in 243 (2.6 percent) and provoked in 205 (2.2 percent) o f the patients. The ages of the patients ranged from 13 to 75 years (m ean of 42.5 years) in the spontaneous and 16 to 70 years (mean of 37.8 years) in the provoked discharge group. When a palpable mass was foun d, biopsy was undertaken, while in instances of nipple discharge only, subareolar exploration was performed. Of the 115 patients in the spon taneous and 25 patients in the provoked groups who underwent biopsy, t he most frequent cause of nipple discharge was intraductal papilloma ( 47.8 percent). Nipple discharge was the result of carcinoma in 35 pati ents (14.4 percent) in the spontaneous and six patients (2.9 percent) in the provoked group, respectively. In patients with a palpable mass, the incidence of carcinoma was 61.5 percent compared with 6.1 percent in patients with nipple discharge only. Patients presenting with nipp le discharge should undergo biopsy or subareolar exploration based on the presence or absence of a palpable tumor. The patients in whom no c linical findings could be detected should have follow-up evaluation at regular intervals.