Validation study of a modern treatment algorithm for nipple discharge

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

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

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 - Aug 2014

Keywords

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

ASJC Scopus subject areas

  • Surgery

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