Is it time to stop performing cytology in patients presenting with nipple discharge to symptomatic breast clinic?

Introduction. Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic. Benign and malignant causes of spontaneous nipple discharge continue to be difficult to distinguish. We analyse our experience of duct excisions for spontaneous nipple discharge to try to identify features that raise suspicion of breast cancer and to identify features indicative of benign disease that would be suitable for nonoperative management.Methods. Details of one hundred and ninety-four patients who underwent duct excision for spontaneous nipple discharge between 1995 and 2005 were analysed.Results. Malignant disease was identified in 11 (5.7%) patients, 4 invasive and 7 insitu, which was 10.2% of those presenting with bloodstained discharge. All patients with malignant disease had bloodstained discharge. Discharge due to malignant disease was more likely to be bloodstained than that due to benign causes (Fisher's exact test, 2-tailedPvalue = 0.00134).Conclusion. Our findings do not support a policy of conservative management of spontaneous bloodstained nipple discharge. Cases of demonstrable spontaneous bloodstained nipple discharge should undergo duct excision to prevent malignant lesions being missed.

Download Full-text

Sensitivity and missed cancer rate in the symptomatic breast clinic—A retrospective cohort study of 40 323 patients

The Breast Journal ◽

10.1111/tbj.14134 ◽

2020 ◽

Author(s):

Jeremy Batt ◽

Rachel Ainsworth ◽

Zenon Rayter ◽

James Nickells ◽

Alexandra Valencia

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Breast Clinic ◽

Cancer Rate ◽

Symptomatic Breast

Download Full-text

Commentary on: Incidental Breast Cancers Identified in a One-Stop Symptomatic Breast Clinic

Journal of Breast Cancer ◽

10.4048/jbc.2011.14.2.165 ◽

2011 ◽

Vol 14 (2) ◽

pp. 165

Author(s):

Jeong Eon Lee ◽

Jung-Hyun Yang ◽

Seok Jin Nam

Keyword(s):

Breast Cancers ◽

Breast Clinic ◽

One Stop ◽

Symptomatic Breast

Download Full-text

A two month retrospective audit of referrals to Symptomatic Breast Clinic from the primary health care setting

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.02.230 ◽

2016 ◽

Vol 42 (5) ◽

pp. S60

Author(s):

Devina Brown ◽

Michael McKirdy ◽

C. Musyoka ◽

K. Krupa ◽

Mary Morrogh

Keyword(s):

Health Care ◽

Primary Health Care ◽

Care Setting ◽

Health Care Setting ◽

Breast Clinic ◽

Primary Health Care Setting ◽

Primary Health ◽

Retrospective Audit ◽

Symptomatic Breast

Download Full-text

Breast surgery (DRAFT)

10.1093/med/9780198749813.003.0005 ◽

2018 ◽

Cited By ~ 1

Author(s):

Jenna Morgan ◽

Lynda Wyld

Keyword(s):

Screening Programme ◽

Breast Surgery ◽

Nipple Discharge ◽

Breast Disease ◽

Breast Screening Programme ◽

Symptomatic Disease ◽

Familial Cancers ◽

Breast Lumps ◽

Asymptomatic Disease ◽

Symptomatic Breast

Breast disease is a common surgical problem. It constitutes symptomatic disease, including breast lumps, nipple discharge, and breast abscesses, as well as asymptomatic disease detected on the NHS Breast Screening Programme (BSP) and patients identified at high risk of familial cancers. It is a busy subspecialty. Referrals for symptomatic breast disease primarily arise from primary care, where they constitute approximately 3% of general practice consultations. In addition, the NHS BSP screened over 2,000,000 women in 2014, of which 4.3% were referred for assessment. The cases in this chapter cover presentations that will be commonly encountered within the breast surgery unit, including the assessment of a breast lump and the surgical management of underlying benign and malignant pathology. It also covers the assessment and management of nipple discharge, as well as lactational and non-lactational breast abscess.

Download Full-text

Mammography in Symptomatic Women Attending a Rapid Diagnosis Breast Clinic: A Prospective Study

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x98603 ◽

2006 ◽

Vol 88 (3) ◽

pp. 306-308 ◽

Cited By ~ 2

Author(s):

MJP Biggs ◽

D Ravichandran

Keyword(s):

Breast Cancer ◽

Significant Proportion ◽

Management Plan ◽

Clinical Findings ◽

Rapid Diagnosis ◽

Breast Cancers ◽

Breast Clinic ◽

Breast Radiologist ◽

A Prospective Study ◽

Symptomatic Breast

INTRODUCTION We determined whether it is safe to avoid mammograms in a group of symptomatic women with a non-suspicious history and clinical examination. PATIENTS AND METHODS Symptomatic women aged 35 years or over newly referred to a rapid-diagnosis breast clinic underwent mammography on arrival in the clinic. A breast radiologist reported on the mammograms. An experienced clinician who was unaware of the mammogram findings examined patients and decided whether a mammogram was indicated or not. If not, a management plan was formulated. Mammogram findings were then provided to the clinician and any change to the original management plan as a result of mammography was recorded. RESULTS In two-thirds (67%) of 218 patients, the clinician felt a mammogram was indicated. Half (46%) of these mammograms showed an abnormality; of these abnormal mammograms, 41% were breast cancer. Among the third (n = 71) of mammograms felt not to be indicated, 3 showed abnormalities of which 2 were breast cancer. One cancer was not suspected clinically or mammographically but was diagnosed on cyto/histopathological assessment. CONCLUSIONS A significant proportion of patients attending a symptomatic breast clinic have a non-suspicious history and normal clinical findings on examination. However, even in this group avoiding mammograms risks missing clinically occult breast cancers. It would appear sensible to offer mammograms to all symptomatic women over 35 years of age.

Download Full-text