Cytological features, clinico-radiological approach and the ratio of breast carcinoma in pathological nipple discharge

AIM: Nipple discharge represents 4-7% of all references to breast clinics. The most frequent reason of nipple discharge is benign etiology. Cancer frequency differs from 6% to 23% in different studies. Standart approach to the patients who refer to the hospital with the complaint of nipple discharge is detailed anamnesis, physical examining, cytological examination by taking patient?s age into consideration and if necessary ultrasonography, mammography, ductulography. But none of these methods is sufficient and reliable enough to exclude an existing malignancy. The aim in this study is to compare the cytopathological results of the cases which had pathological nipple discharge with the results of pathological examination of their subareolar exploration and excisional biopsy specimens and to discuss what is the best approach to the patients whose lesions could not be determined by radiodiagnostic examination.METHODS: Between September 1998- January 2010, 102 cytological specimens of pathological nipple discharge were sent to Pathology Department of Dokuz Eylul University, School of Medicine. 57 cases which had subareolar exploration, excisional biopsy or mastectomy after cytological examination were included to the study. The cytopathological and histopathological diagnosis of the cases that had nipple discharge were compared and cytological diagnostic value of nipple discharge and the ratio of malignancy were determined. The cases diagnosed histopathologically as malignant were compared to their radiological examination results.RESULTS: 2 of 57 cases were male. Nipple discharge was the only presentation complaint. After examination of cytological specimens of these cases, atypical ductal epithelial cells were seen in 39 cases (68.5%) and malignant cells were determined in 4 cases (7.0%). 6 cases (10.5%) were diagnosed as benign and 8 cases (14.0%) were accepted as insufficient for diagnosis.After histopathological examination, 28 cases (49.1%) had invasive or in situ carcinoma, 27 cases (47.4%) had benign changes including papilloma/papillomatosis in 19 cases, and 2 cases (3.5%) had atypical changes. In the histopathological examination of 43 cases which had atypical ductal epithelial cells or malignant cells in cytopathological specimens, in situ or invasive carcinoma were determined in 25 cases (58.1%), intraductal papilloma/papillomatosis were determined in 12 cases (27.9%), 3 cases (7%) showed ductal/papillary hyperplasia, 2 cases (4.7%) had atypical changes and 1 case (2.3%) showed ductal ectasia. Among 28 cases that were diagnosed as carcinoma after excisional biopsy or subareolar exploration, we could reach the radiological examination results of 24 cases.Only galactography was performed to 2 of these 24 cases and ?obliterated ductus? was determined in 1 of 2, ?irregular filling defect? was seen in the other case. Mammography and ultrasonography were performed to the last 22 cases . Radiologically, 10 of these 22 cases (45.5%) did not give rise to suspicion of malignancy. 4 of 10 cases were evaluated as normal, 1 showed ?retroareolar dilated channel?, 2 showed ?intraductal papilloma?, 1 case was evaluated as ?BIRADS-2 lesion? and 2 cases were evaluated as ?BIRADS-3 lesion?. Among 12 of 22 cases (54.5%), 6 were diagnosed as ?BIRADS-4 lesion?, 6 were diagnosed as ?BIRADS-5 lesion?.CONCLUSION: We conclude that when nipple discharge is present, in addition to radiological examinations, excisional biopsy or subareolar exploration should be performed to the cases which were cytologically diagnosed as ?malignancy/atypical ductal epithelial cells? and in cases having benign or nondiagnostic cytology, radiological examination, clinical follow up and subareolar exploration is very important.