Navigating murky waters: a modern treatment algorithm for nipple discharge

Richard J. Gray, Barbara A. Pockaj, Patricia J. Karstaedt

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background: Many women with nipple discharge undergo operative duct excision with few actually having carcinoma. Methods: We reviewed all patients with nipple discharge at our institution from 2001 to 2005. Clinical findings were analyzed to determine an appropriate treatment algorithm. Results: Nipple discharge was present in 204 patients. Carcinoma was identified in 7 patients (3% of all, 9% of those undergoing biopsy). Age ≥50 years, abnormal mammography, and abnormal sonography were the only significant predictors of carcinoma. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram, the carcinoma risk was 3%. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram and subareolar ultrasound, the carcinoma risk was 0%. Conclusions: Patients with nipple discharge can be divided into risk groups by combining clinical and radiologic findings. Low-risk patients can be offered close clinical follow-up rather than operation. A recommended management algorithm is presented.

Original languageEnglish (US)
Pages (from-to)850-855
Number of pages6
JournalAmerican journal of surgery
Volume194
Issue number6
DOIs
StatePublished - Dec 1 2007

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Keywords

  • Breast
  • Breast discharge
  • Nipple discharge

ASJC Scopus subject areas

  • Surgery

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