title: Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge.
abstract: BACKGROUND
  There is no consensus about the use of the various diagnostic tests and surgical procedures available to confirm or rule out breast cancer in patients presenting with nipple discharge. This study was designed to identify patient and nipple-discharge characteristics associated with the diagnosis of breast cancer and to determine the utility of mammography, sonography, ductography, and cytology in surgical decision making in patients presenting with pathologic nipple discharge.
  
  
  METHODS
  We reviewed the medical records of all patients who presented with nipple discharge at our institution between August 1993 and September 2000. Patient and nipple-discharge characteristics and findings on imaging studies and cytologic examination were analyzed.
  
  
  RESULTS
  A total of 146 patients presented at our institution with nipple discharge during the study period. Of these, 52 had clinically benign discharge and were managed without surgical intervention; 94 patients had pathologic discharge and underwent a biopsy procedure for histologic diagnosis, treatment, or both. Logistic regression analysis identified mammographic (relative risk [RR] = 10.47, 95% confidence interval [CI] 2.36 to 46.39, p = 0.0002) and sonographic (RR = 5.54, 95% CI 1.27 to 25.40, p = 0.028) abnormalities as independent factors associated with a malignant diagnosis. Nineteen cancers, 62 papillomas, and 13 other benign lesions were identified among the patients with pathologic discharge. In 3 patients with cancer (15.8%) and 30 patients with a papilloma (48.4%), ductography was the only means of identifying lesions to be resected. Patients who underwent ductography-guided operation (n = 42, 50%) or any surgical procedure including a localization study (n = 66, 78.6%) were significantly more likely than patients who underwent central duct excision alone to have a specific underlying lesion identified (p = 0.045 and p = 0.033, respectively).
  
  
  CONCLUSIONS
  Abnormalities on mammography and sonography in patients with nipple discharge should alert physicians to the possibility of a breast cancer diagnosis. In patients with pathologic discharge with normal findings on physical examination and other imaging studies, ductography might be the only means of localizing and resecting breast lesions associated with nipple discharge.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Cabioglu
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Tanya W
authors.initials: TW
authors.lastname: Stephens
authors.forename: Sylvie
authors.initials: S
authors.lastname: Marcy
authors.forename: Funda
authors.initials: F
authors.lastname: Meric
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Ames
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001941:Breast Diseases / Q000175:diagnosis / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D003937:Diagnosis, Differential; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008499:Medical Records; D008875:Middle Aged; D009558:Nipples / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary