title: What is the diagnostic value of nipple discharge cytology and galactography in detecting duct pathology?
abstract: The present study aimed to evaluate the diagnostic value of nipple discharge (ND) cytology and galactography. Ninety-four patients submitted to duct excision, representing a total of 98 duct excisions, were retrospectively analyzed from January 1997 to May 2007. Histology of ducts excised revealed 35% duct ectasia (DE), 31% duct papilloma (DP), 20% potential malignant transforming lesions (PMTL), 6% breast cancer (BC), 1% adenoma and 6% normal breast tissue. Cytology had a sensibility and specificity in detecting duct pathology of, respectively, 40% and 61.3%, a positive predictive value (PPV) of 53.8% and a negative predictive value (NPV) of 47.5%. Concerning malignant and PMTL, cytology had a sensibility and specificity of, respectively, 46.2% and 62.3%, a PPV of 25% and a NPV of 82.5%. Breast cancer was never suggested by positive cytology. Galactography had a sensibility and specificity in detecting duct pathology of, respectively, 77.4% and 29.2%, a PPV of 58.5% and a NPV of 50%. For malignant and PMTL, galactography had a sensibility and specificity of, respectively, 80% and 26.7%, a PPV of 19.5% and a NPV of 85.7%. However, galactography never suggested a diagnosis of cancer. Cytology and galactography performed together in 49% showed a low Kappa Index (KI < 1), allowing us to conclude that cytology and galactography detect different pathologies. Cytology showed a poor performance in predicting histological diagnosis in face of ND. Galactography had a good sensibility in excluding malignant lesions and PMTL. Galactography was significantly more sensitive for duct pathology but cytology was more specific for malignant lesions and PMTL.
authors.affiliation: Department of Gynaecology, University Hospital of Coimbra, Coimbra, Portugal. mariaj.carvalho@sapo.pt
authors.forename: M J
authors.initials: MJ
authors.lastname: Carvalho
authors.forename: M
authors.initials: M
authors.lastname: Dias
authors.forename: M
authors.initials: M
authors.lastname: Gonçalo
authors.forename: G
authors.initials: G
authors.lastname: Fernandes
authors.forename: V
authors.initials: V
authors.lastname: Rodrigues
authors.forename: C F
authors.initials: CF
authors.lastname: de Oliveira
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology*; D008327:Mammography; D008875:Middle Aged; D055966:Nipple Aspirate Fluid; D010212:Papilloma / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity; D055815:Young Adult