Surgical approach to nipple discharge: A ten-year experience

Background and Objectives: The actual relationship between malignancy and s ecreting breast has not yet been extensively verified, mainly in patients w ith nipple discharge but without evidence of a breast lump. This study was carried out in 1,251 consecutive patients to evaluate the reliability of cy tology combined with galactograghy in order to assess the relationship of m alignant and premalignant lesions with discharge without the presence of a breast lump. Methods: Those patients with bilateral discharge were approached endocrinol ogically, whereas the patients (433) with unilateral secretion were evaluat ed by cytology. mammography, fine needle biopsy, and galactography. Of 194 patients without a breast lump, 94 with positive cytology were surgically t reated after mammogalactography. Surgical treatment included ductgalactopho rectomy in 53, segmentectomy in 23, microdochectomy in 13, and mastectomy i n 5 patients. Results: Pathologic findings showed a solitary papilloma in 49 cases, minim al breast cancer in 20, fibrocystic disease in 11, papillomatosis in 7, lob ular cancer in 5, and, finally, a duct ectasia in 2. Conclusions: In the patients with secreting breast but without lump, cytolo gical analysis in addition to galactography seems to be useful in identifyi ng minimal breast cancer and in detecting premalignant lesions like papillo matosis. J. Surg. Oncol. 1999;71:235-238 (C) 1999 Wiley-Liss, Inc.