The association of bloody nipple discharge with breast pathology.
BACKGROUND
It is believed that bloody spontaneous nipple discharge (SND) portends a greater chance of malignancy than nonbloody discharge, and that cytologic evaluation of SND assists in treatment planning. Our aims were to assess (1) the pathology of women with/without SND who require diagnostic breast surgery, (2) whether bloody SND is associated with a different spectrum of pathologic findings than nonbloody, and (3) whether SND cytology is influenced by pathologic findings.


METHODS
One hundred seventy-five women who underwent breast operation were enrolled. Cytologic evaluation was performed on Papanicolaou-stained cytospin preparations of SND.


RESULTS
Papilloma and hyperplasia (both without atypia) were more frequent in breasts with than without SND; breast cancer was more common in breasts without SND (P <.001 for all). All cases of breast cancer with SND, but only 33% without, contained a papilloma or papillary features. Seventy-five percent of cancers presenting with SND were nonbloody. Papilloma was the most common diagnosis in breasts with bloody SND and was more common (P=.017) than in breasts without, whereas hyperplasia was the most common diagnosis in breasts with nonbloody SND and was more common (P=.031) than in breasts with bloody SND. SND cytology was not significantly influenced by pathology.


CONCLUSIONS
Breast cancer can present as unilateral nonbloody SND, indicating the importance of surgical intervention. Papilloma was more common in women with SND than without and most often presented as bloody SND.
Department of Surgery, University of Missouri-Columbia/Ellis Fischel Cancer Center, Columbia MO 65212, USA.
Edward R
ER
Sauter
Lisa
L
Schlatter
John
J
Lininger
John E
JE
Hewett
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012634:Bodily Secretions / Q000166:cytology; D001941:Breast Diseases / Q000150:complications / Q000473:pathology; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology*; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism*; D010212:Papilloma / Q000150:complications / Q000473:pathology*