scholarly journals Duct Excision is Still Necessary to Rule out Breast Cancer in Patients Presenting with Spontaneous Bloodstained Nipple Discharge

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
R. E. Foulkes ◽  
G. Heard ◽  
T. Boyce ◽  
R. Skyrme ◽  
P. A. Holland ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Malignant Disease ◽  
Nonoperative Management ◽  
Nipple Discharge ◽  
Breast Clinic ◽  
Exact Test ◽  
Malignant Lesions ◽  
Duct Excision ◽  
Symptomatic Breast ◽  
Rule Out

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.

scholarly journals Predicting Patients Found to Have Malignancy at Nipple Duct Surgery

Breast Care ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 491-497
Author(s):  
Nour Alshurbasi ◽  
Christopher W. J. Cartlidge ◽  
Stanley R. Kohlhardt ◽  
Sirwan M. Hadad
Keyword(s):  
Malignant Disease ◽  
Ductal Carcinoma ◽  
Nipple Discharge ◽  
Benign Disease ◽  
Presenting Symptoms ◽  
Benign Pathology ◽  
Fibrocystic Change ◽  
Ductal Hyperplasia ◽  
Malignant Lesions ◽  
Duct Excision

Introduction: The unexpected diagnosis of breast cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, pre-operative diagnosis of malignancy still evades us. The aim of this study was to review the pathological findings of total duct excision and microdochectomy with reference to pre-operative symptoms, ultrasound, or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods: Data were collected retrospectively of all patients who underwent total duct excision surgery in a single centre (2011–2017). Pre-operative demographics, symptoms, and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data were available for 211. Median age was 53 years. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10%) had “risk” lesions (papilloma with atypia, atypical ductal hyperplasia), and 15/211 (7.1%) had malignancy (ductal carcinoma in situ). Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1). 71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7%) had “risk” lesions, and 6/71 (8.5%) had malignant lesions. 83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk, and 10/83 (12%) malignancy. 38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk, and 2/38 (5.3%) malignant lesions. ­Conclusion: Neither imaging nor presenting symptoms correlate with the likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.

scholarly journals Meta-analysis and cost-effectiveness of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge

2021 ◽  
Author(s):  
M. D. Filipe ◽  
S. I. S. Patuleia ◽  
M. R. Vriens ◽  
P. J. van Diest ◽  
A. J. Witkamp
Keyword(s):  
Breast Cancer ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Nipple Discharge ◽  
Diagnostic Methods ◽  
Diagnostic Strategy ◽  
Breast Clinic ◽  
Diagnostic Efficacy ◽  
Significant Difference ◽  
Duct Excision

Abstract Introduction Pathological nipple discharge (PND) is a common breast-related complaint for referral to a surgical breast clinic because of its association with breast cancer. The aim of this meta-analysis was to compare the diagnostic efficacy of magnetic resonance imaging (MRI) and ductoscopy in patients with PND. Additionally, we determined the most cost-efficient strategy for the treatment of PND and the detection of breast cancer in PND patient without radiological suspicion for malignancy. Materials and methods PubMed and EMBASE were searched to collect the relevant literature from the inception of both diagnostic methods until January 27th 2020. The search yielded 815 original citations, of which 10 studies with 894 patients were finally included for analysis. Costs of ductoscopy, MRI and duct excision surgery were obtained from the UMC Utrecht as established in the year 2019. These costs included: medical personnel, overhead costs, material costs and sterilisation costs. Results The meta-analysis showed no significant difference in sensitivity between ductoscopy (44%) and MRI (76%) for the detection of malignancy in patients with PND. However, ductoscopy (98%) had a statistically significantly higher specificity than MRI (84%). Individual costs were €1401.33, €822.13 and €6494.27 for ductoscopy, MRI and duct excision surgery, respectively. Full diagnostic strategy involving ductoscopy was on average €1670.97, while with MRI it was €2070.27. Conclusion Patients undergoing MRI are more often (false) positive which more often leads to duct excision surgery referrals compared to ductoscopy. This makes ductoscopy significantly more cost-effective compared MRI in patients with PND without radiological suspicion for malignancy.

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

2006 ◽  
Vol 88 (3) ◽  
pp. 306-308 ◽  
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.

scholarly journals COMPARISON OF MAMMOGRAPHY AND ULTRASOUND COMBINED VERSUS ULTRASOUND ALONE IN EARLY EVALUATION OF SYMPTOMATIC BREAST CANCERS IN PAKISTAN

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Razia Bano ◽  
Huma M Khan ◽  
Ayesha Ehsan ◽  
Awais Amjad Malik ◽  
Shahper Aqeel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Failure Rate ◽  
Clinical Findings ◽  
Initial Evaluation ◽  
Breast Lesions ◽  
Breast Cancers ◽  
Breast Clinic ◽  
Early Evaluation ◽  
Symptomatic Breast

Purpose: The purpose of this study was to detect diagnostic accuracy of mammography and ultrasound combined versus ultrasound alone in early evaluation of symptomatic breast lesions.Materials and Methods: All new patients who presented to the breast clinic with symptomatic breast lesions, during the year 2012, were included in the study. A total of 695 patients were registered. Their clinical findings, mammogram, ultrasound and histopathology were reviewed.Results: Mammogram and ultrasound combined detected 693 (99.71%) lesions in total. Mammogram failed to detect lesions in 1.43% of patients, whereas the failure rate of ultrasound was 0.43%. The incidence of microcalcifications on mammogram was 19.13%.Conclusion: Ultrasound is a useful tool in the initial evaluation of symptomatic breasts. For places such as Pakistan where mammogram is not available at every centre, ultrasound can be used as an effective alternative for the assessment of symptomatic breast lesions.Key words: Breast cancer, mammography, ultrasound

scholarly journals AB210. Trends in the age profile of breast cancer presentations to the symptomatic breast clinic in the era of breast cancer screening

2020 ◽  
Vol 4 ◽  
pp. AB210-AB210
Author(s):  
Hannah Markey ◽  
Anna Heeney ◽  
Colm Power ◽  
Arnold David Konrad Hill ◽  
Deirdre Duke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Breast Clinic ◽  
Age Profile ◽  
Symptomatic Breast

scholarly journals Nipple Discharge: A Sign of Breast Cancer?

2007 ◽  
Vol 89 (2) ◽  
pp. 124-126 ◽  
Author(s):  
T Richards ◽  
A Hunt ◽  
S Courtney ◽  
H Umeh
Keyword(s):  
Breast Cancer ◽  
Blood Cells ◽  
Watchful Waiting ◽  
Nipple Discharge ◽  
District General Hospital ◽  
Cancer Type ◽  
Cytological Examination ◽  
Occult Malignancy ◽  
Duct Excision ◽  
Breast Cancer Type

INTRODUCTION Nipple discharge is regarded a sign of breast cancer. Type of discharge and cytology are unreliable for diagnosis. Most malignant cases have a detectable breast mass. The aim of this study was to assess the association between nipple discharge and breast cancer. PATIENTS AND METHODS Patients who underwent operation for nipple discharge at a district general hospital (population 460,000) over a 3-year period were included. All had normal clinical, radiological and cytological examination. Operation and histopathology reports were reviewed. RESULTS Eighty-six patients underwent operation for nipple discharge. Median age was 54 years (range, 32–84 years). Analysis of nipple discharge revealed red blood cells (RBCs) in 35 patients (40%). At operation, 81 patients underwent radical sub-areola duct excision (Hadfield's procedure) and five microdochectomy. Histopathology reported duct ectasia in 59 patients and benign ductal papilloma in 25. Two patients had occult malignancy – DCIS (1) and LCIS (1). No invasive cancer was found. CONCLUSIONS Nipple discharge alone is not usually a sign of breast cancer. Occult malignancy is rare. A period of ‘watchful waiting’ may prevent patients undergoing unnecessary surgery.

scholarly journals Spectrum of Diseases among Patients Attending a Breast Clinic at a Tertiary Level Hospital of Bangladesh

2019 ◽  
Vol 9 (1) ◽  
pp. 11-13
Author(s):  
Tamanna Narmeen ◽  
MM Masud Pervez
Keyword(s):  
Breast Cancer ◽  
Breast Screening ◽  
Nipple Discharge ◽  
Skin Lesions ◽  
Breast Diseases ◽  
Breast Clinic ◽  
Eligibility Criteria ◽  
Disease Spectrum ◽  
Superficial Skin ◽  
Giant Fibroadenoma

Background: Breast problems are a burning health issue for today’s women. Breast clinics provide a competent and complete diagnosis for women with any breast symptoms or problems and give appropriate management of the problem. The aim of this study is to determine the disease spectrum among the patients visiting a breast clinic for assistance. Methods: This was a cross section study of all female patients visiting a breast clinic with breast problems. The study was conducted at BIRDEM General Hospital-2 over a period of 3 years from March 2015 till March 2018. Patients suffering from superficial skin lesions of the breast were excluded. The findings were tabulated and analyzed for frequency of each problem. Results: A total of 1279 patients visited the breast clinic during the period of March 2015 till March 2018. Among them 1204 patients were selected after considering eligibility criteria. The age of the patients ranged from 15 to 80 years. Ten percent of these patients were asymptomatic and attended the clinic for breast screening. Among the symptomatic patients mastalgia was the most common presentation (36.65%) followed by fibrocystic disease (22.26%). Benign Breast lump was seen in 14.96% patients. Ten percent patients presented with breast abscess. Nipple discharge and ductal ectasia was seen in 2.66% patients. Breast cancer was found in 2.33% patients. Other rare entities like milk fistula, giant fibroadenoma were also noted. Conclusion: Breast clinincs provide comprehensive assistance to both benign and malignant breast diseases. Breast cancer is the leading cause of cancer deaths in females. Breast screening ensures early detection of breast cancer. Besides malignant disease benign breast diseases also cause much morbidity to female health. This study shows the spectrum of patients coming with breast complaints to such a breast clinic. Birdem Med J 2019; 9(1): 11-13

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