Nipple discharge disorders: current diagnostic management and the role of fiber-ductoscopy

Nipple discharge disorders is a field in which there has been both increasi ng awareness on the part of patients and advances in management. Today: sec retion from nipples can be classified according to its color, cellularity a nd biology To be significant a discharge should be true, spontaneous, persi stent and non-lactational. Moreover there are methods to differentiate pati ents who require surgical intervention from those who do not. Surgically si gnificant nipple discharges are watery, serous (yellow), serosanguineous an d bloody Cytology smears of discharge material have helped to classify the cellular material, providing information about normality, atypia and malign ancy and also about papillary formation of the exfoliated cells. Tests such as Hemoccult help to discover occult blood in the secreted fluid. Modern i mmunological tests can be performed on cytology smears where occurrence of high levels of carcinoembryonic antigen could indicate a latent malignancy. Galactography investigation is today the state-of-the-art approach to inve stigate patients with nipple discharge disorders and this examination can d emonstrate the size, location and extent of an intraductal abnormality. Mod ern high-resolution ultrasound techniques are helpful in visualizing intrad uctal disorders and are becoming a good complementary approach if not an al ternative to traditional radiology techniques. Recently even MR galactograp hy has been shown to be of diagnostic value, but not as informative as regu lar galactography. The most sophisticated investigation method, which can a lso be used therapeutically, is fiber-ductoscopy of the concerned induct in a breast. This technique, although expensive and in its infancy, is a fasc inating and promising approach far inspecting the intraductal lumina. In th is article the background, current investigation methods and possibilities of the technique are described, as well as the most sophisticated ways to d eal with nipple discharge disorders in human breasts.