Validation study of a modern treatment algorithm for nipple discharge

Awais Ashfaq, Derek Senior, Barbara A Pockaj, Nabil Wasif, Victor Pizzitola, Marina E. Giurescu, Richard J. Gray

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients. Methods Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm. Results A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%). Conclusions Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure.

Original languageEnglish (US)
Pages (from-to)222-227
Number of pages6
JournalAmerican Journal of Surgery
Volume208
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Validation Studies
Therapeutics
Carcinoma
Carcinoma, Intraductal, Noninfiltrating
Nipple Discharge
Breast

Keywords

  • Breast cancer
  • Nipple discharge
  • Treatment algorithm
  • Validation study

ASJC Scopus subject areas

  • Surgery

Cite this

Validation study of a modern treatment algorithm for nipple discharge. / Ashfaq, Awais; Senior, Derek; Pockaj, Barbara A; Wasif, Nabil; Pizzitola, Victor; Giurescu, Marina E.; Gray, Richard J.

In: American Journal of Surgery, Vol. 208, No. 2, 2014, p. 222-227.

Research output: Contribution to journalArticle

Ashfaq, Awais ; Senior, Derek ; Pockaj, Barbara A ; Wasif, Nabil ; Pizzitola, Victor ; Giurescu, Marina E. ; Gray, Richard J. / Validation study of a modern treatment algorithm for nipple discharge. In: American Journal of Surgery. 2014 ; Vol. 208, No. 2. pp. 222-227.
@article{2dba48ff75df4fbba76ba2a8749feeff,
title = "Validation study of a modern treatment algorithm for nipple discharge",
abstract = "Background Nipple discharge occurs in 2{\%} to 5{\%} of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients. Methods Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm. Results A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5{\%}. Breast surgeon was consulted for 142 (74{\%}) patients: 48 (34{\%}) underwent initial subareolar excision and 94 (66{\%}) were clinically followed. The rate of carcinoma was 17{\%} (8/48) after initial subareolar excision, 0{\%} (0/13) for those without imaging abnormalities, 23{\%} (8/35) with imaging abnormalities, and 1{\%} (1/94) with clinical follow-up. Of patients who underwent follow-up, 21{\%} (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1{\%}) or persistent discharge (n = 19, 20{\%}). Most patients had ductal carcinoma in situ (n = 5, 56{\%}). Conclusions Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure.",
keywords = "Breast cancer, Nipple discharge, Treatment algorithm, Validation study",
author = "Awais Ashfaq and Derek Senior and Pockaj, {Barbara A} and Nabil Wasif and Victor Pizzitola and Giurescu, {Marina E.} and Gray, {Richard J.}",
year = "2014",
doi = "10.1016/j.amjsurg.2013.12.035",
language = "English (US)",
volume = "208",
pages = "222--227",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Validation study of a modern treatment algorithm for nipple discharge

AU - Ashfaq, Awais

AU - Senior, Derek

AU - Pockaj, Barbara A

AU - Wasif, Nabil

AU - Pizzitola, Victor

AU - Giurescu, Marina E.

AU - Gray, Richard J.

PY - 2014

Y1 - 2014

N2 - Background Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients. Methods Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm. Results A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%). Conclusions Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure.

AB - Background Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients. Methods Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm. Results A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%). Conclusions Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure.

KW - Breast cancer

KW - Nipple discharge

KW - Treatment algorithm

KW - Validation study

UR - http://www.scopus.com/inward/record.url?scp=84905089949&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905089949&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2013.12.035

DO - 10.1016/j.amjsurg.2013.12.035

M3 - Article

VL - 208

SP - 222

EP - 227

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 2

ER -