Validation study of a modern treatment algorithm for nipple discharge.
BACKGROUND
Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients.


METHODS
Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm.


RESULTS
A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%).


CONCLUSIONS
Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure.
Department of Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Awais
A
Ashfaq
Department of Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Derek
D
Senior
Department of Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Barbara A
BA
Pockaj
Department of Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Nabil
N
Wasif
Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Victor J
VJ
Pizzitola
Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Marina E
ME
Giurescu
Department of Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA. Electronic address: gray.richard@mayo.edu.
Richard J
RJ
Gray
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001941:Breast Diseases / Q000175:diagnosis* / Q000453:epidemiology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000453:epidemiology; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D055966:Nipple Aspirate Fluid; D016217:Ultrasonography, Mammary; D055815:Young Adult
Breast cancer; Nipple discharge; Treatment algorithm; Validation study