title: The role of major duct excision and microdochectomy in the detection of breast carcinoma.
abstract: BACKGROUND
  The association of nipple discharge with breast carcinoma has resulted in numerous women undergoing exploratory surgery to exclude malignancy. The aim of this study was to determine whether pre-operative factors can identify those patients that are most at risk of carcinoma.
  
  
  METHODS
  All patients over a 14-year period (1991-2005) who had a microdochectomy or subareolar exploration for the evaluation of nipple discharge were assessed. Patient characteristics, pre-operative imaging and pathological findings were analysed.
  
  
  RESULTS
  Of the 211 patients included in this study, 116 patients had pathological (unilateral, uniductal serous or bloody) discharge. On excision, 6% (n = 7) of patients with pathological discharge and 2.4% (n = 2) of patients with non-pathological discharge were diagnosed with carcinoma. Overall, major duct excision resulted in the diagnosis of carcinoma in 4.3% (n = 9), ADH/LCIS in 4% (n = 8), papilloma in 39% (n = 83), and duct ectasia or non-specific benign disease in 53% (n = 111) of patients. In the patients determined to have malignancy, 44% (n = 4) were premenopausal. No patient with a non-bloody discharge in the total population analysed (28%; n = 59/211), or in the population with a pathological discharge (21%; n = 24/116) was found to have carcinoma upon excision.
  
  
  CONCLUSIONS
  Microdochectomy or major duct excision performed for nipple discharge resulted in a low rate of malignancy on excision. Conservative management of non-bloody nipple discharge can be considered in patients with no other clinical or radiological signs of malignancy.
authors.affiliation: Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. maryfdillon@hotmail.com
authors.forename: Mary F
authors.initials: MF
authors.lastname: Dillon
authors.forename: Shah R
authors.initials: SR
authors.lastname: Mohd Nazri
authors.forename: Shaaira
authors.initials: S
authors.lastname: Nasir
authors.forename: Enda W
authors.initials: EW
authors.lastname: McDermott
authors.forename: Denis
authors.initials: D
authors.lastname: Evoy
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Crotty
authors.forename: Niall
authors.initials: N
authors.lastname: O'Higgins
authors.forename: Arnold D K
authors.initials: AD
authors.lastname: Hill
mesh_terms: D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005122:Exudates and Transudates; D005188:False Negative Reactions; D005260:Female; D018226:Fibroadenoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D042361:Mammary Glands, Human / Q000601:surgery*; D008327:Mammography; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D010173:Palpation; D010212:Papilloma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D017697:Premenopause; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity