Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic mammotome biopsy

OBJECTIVE. The purpose of this study was to evaluate imaging-guided vacuum- assisted mammotome biopsy as a minimally invasive method of obtaining a sat isfactory diagnosis and eliminating the bothersome symptoms in patients pre senting with nipple discharge. MATERIALS AND METHODS. Forty-nine women who presented with nipple discharge and who had final pathologic diagnoses of papillary lesions were retrospec tively identified. Fifty-six lesions were biopsied in this group. The exami nations included mammography, ductography, sonography, and if possible, per cutaneous biopsy. All lesions were centrally located and most were superfic ial. Of this study group, four patients with five lesions proceeded to sono graphically guided automated core biopsy, and 38 patients with 44 intraduct al lesions identified by sonography advanced to sonographically guided biop sy with an 11-gauge mammotome probe. One patient underwent stereotactic 11- gauge mammotome biopsy. Patients not advancing to sonographically guided bi opsy were those with masses either in the nipple or nipple-areolar complex (five patients), one patient with no identifiable lesion at sonography, and one directly referred for open surgical biopsy. RESULTS. In all biopsied patients, satisfactory tissue for diagnosis was ob tained. In patients biopsied with the mammotome probe, follow-up at a mean time of 13 months revealed resolution of the presenting problematic dischar ge in 97.2% of patients. Complications were mild and infrequent. Only one o f 50 percutaneously biopsied lesions was not benign and required subsequent surgery. CONCLUSION. Papilloma excision with percutaneous biopsy allows safe and acc urate tissue analysis and a high probability of terminating the symptomatic nipple discharge.