The role of microductectomy in the diagnosis and treatment in women with pathologic nipple discharge

Abstract

Objectives: Approximately one tenth of the patients who apply to the breast polyclinics complain of nipple discharge. Apart from pregnancy and lactation, spontaneous, unilateral, bloody or serous discharge originating from a single duct describes the Pathological Nipple Discharge (PND). The aim of this study is to show that precancerous breast lesions, which can be easily overlooked by conventional diagnostic methods, are detected with the microductectomy performed with the correct indication and it is possible to complete the appropriate treatment.

Methods: Fifty-five microductectomy procedures were performed in 55 female patients who applied to the relevant clinic with the complaint of nipple discharge between January 2013 and August 2018 and who met at least two of the three criteria of pathological nipple discharge (spontaneous, single ductus, bloody or serous) except pregnancy and lactation. Prospectively collected information was evaluated retrospectively.

Results: The average age of the patients in the study ranged from 23 to 73 years (mean age 45.5 years, median age 47 years). Out of 55 procedures, 28 (50.9%) were performed in women of reproductive age, 27 (49.1%) were performed in women in menopause. The discharge was localized to the right breast in 28 patients, and to the left breast in 27 patients. Forty-one of the 55 patients included in the study met all of the criteria for pathological nipple discharge, while the other 14 patients had at least two of the three criteria. Final pathologies were classified as follows; intraductal papilloma / papillomatosis with atypia, intraductal papillary carcinoma (IPC) and ductal carcinoma in situ (DCIS); Potential Neoplastic and Malignant Lesion (PNML).

Conclusions: In cases where direct intraductal imaging methods cannot be applied in patients admitted to the polyclinic with pathological nipple discharge, microductectomy emerges as an effective diagnosis and treatment method that can be applied with low morbidity.

Keywords

• pathological nipple discharge
• microductectomy
• surgery

References

1. 1. Florio MG, Manganero T, Pollicino A, Scarfo P, Micali B. Surgical approach to nipple discharge: a ten year experience. J Surg Oncol 1999;71:235-8.
2. 2. Doğan BE, Tükel S. Meme akıntısına radyolojik yaklaşım. Türk Tanısal ve Girişimsel Radyoloji Dergisi 2002;8:364-71.
3. 3. Klimberg VS. Nipple discharge: more than pathologic. Ann Surg Oncol 2003;10:98-9.
4. 4. Ballesio L, Maggi C, Savelli S, Angeletti M, De Felice C, Meggiorini ML, et al. Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol Med 2008;113:249-64.
5. 5. Orel SG, Dougherty CS, Reynolds C, Czerniecki BJ, Siegelman ES, Schnall MD. MR imaging in patients with nipple discharge: initial experience. Radiology 2000;216:248-54.
6. 6. Carty NJ, Mudan SS, Ravichhandran D, Royle GT, Taylor I. Prospective study of outcome in women presenting nipple discharge. Ann R Coll Surg Engl 1994;76:387-9.
7. 7. Matsunaga T, Misaka T, Hosokawa K, Taira S, Kim K, Serizawa H, et al. Intraductal approach to the detection of intraductal lesions of the breast. Breast Cancer Res Treat 2009;118:9-13
8. 8. Morrogh M, Morris EA, Liberman L, Borgen PI, King TA. The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol 2007;14:3369-77.

9. 9. Kapenhas-Valdes E, Feldman SM, Cohen JM, Boolbol SK. Mammary ductoscopy for evaluation of nipple discharge. Ann Surg Oncol 2008;15:2720-7.
10. 10. Dawes LG, Bowen C, Venta LA, Morrow W. Ductography for nipple discharge: no replacement for ductal excision. Surgery 1998;124:685-91.
11. 11. Simmons R, Adamovich T, Brennan M, Christos P, Schultz M, Eisen C, et al. Nonsurgical evaluation of pathologic nipple discharge. Ann Surg Oncol 2003;10:113-6.
12. 12. Dietz JR, Crowe JP, Grundfest S, Arrigain S, Kim JA. Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery 2002;132:582-7.
13. 13. Sharma R, Dietz J, Wright H, Crowe J, DiNunzio A, Woletz J, et al. Comparative analysis of minimally invasive microductectomy versus major duct excision in patients with pathologic nipple discharge. Surgery 2005;138:591-6.
14. 14. Fisher CS, Margenthaler JA. A look into the ductoscope: its role in pathologic nipple discharge. Ann Surg Oncol 2011;18:3187-91.
15. 15. Yang X, Li H, Gou J, Tan Q, Wang L, Lin X, et al. The role of breast ductoscopy in evaluation of nipple discharge: a chinese experience of 419 patients. Breast J 2014;20:388-93.
16. 16. Kamali S, Harman Kamali G, Alkan A, Simşek S, Bender O. Use of ductoscopy as an additional diagnostic method and its applications in nipple discharge. Minerva Chir 2014;69:65-73.
17. 17. Fajdic J, Gotovac N, Glavic Z, Hrgovic Z, Jonat W, Schem C. Microduchectomy in the management of pathologic nipple discharge. Arch Gynecol Obstet 2011;283:851-4.
18. 18. Matsunaga T, Ohta D, Misaka T, Hosokawa K, Fujii M, Kaise H, et al. Mammary ductoscopy for diagnosis and treatment of intraductal lesions of the breast. Breast Cancer 2001;8:213-21.
19. 19. Tang SSK, Twelves DJ, Isacke CM, Gui GPH. Mammary ductoscopy in the current management of breast disease. Surg Endosc 2011:25:1712-22.
20. 20. Sabel MS, Helvie MA, Breslin T, Curry A, Diehl KM, Cimmino VM, et al. Is duct exicision stil necessary for all cases of suspicious nipple discharge? Breast J 2012;18:157-62.
21. 21. Kalu ON, Chow C, Wheeler A, Kong C, Wapnir I. The diagnostic value of nipple discharge cytology: breast imaging complements predictive value of nipple discharge cytology. J Surg Oncol 2012;106:381-5.
22. 22. Ohlinger R, Stomps A, Paepke S, Blohmer JU, Grunward S, Hahndorf W, et al. Ductoscopic detection of intraductal lesions in cases of pathologic nipple discharge in comparison with standard diagnostics: the German multicenter study. Oncol Res Treat 2014;37:682-32.
23. 23. Bahl M, Baker JA, Greenup RA, Ghate SV. Diagnostic value of ultrasound in female patients with nipple discharge. AJR Am J Roentgenol 2015;205:203-8.
24. 24. Grunwald S, Heyer H, Paepke S, Schwesinger G, Schimming A, Hahn M, et al. Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to standard methods. Oncologie 2007;30:243-8.
25. 25. Bahl M, Baker JA, Greenup RA, Ghate SV. Evaluation of pathologic nipple discharge: what is the added diagnostic value of MRI? Ann Surg Oncol 2015;22 Suppl 3:S435-41.