Breast: Nipple Discharge

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Chapter 154 Breast: Nipple Discharge

INTRODUCTION

Description: Nipple discharge is a distressing symptom that accounts for roughly 5% of breast complaints.

Prevalence: Three percent to five percent of breast problems, 5% of women who are not lactating, >50% of women can express secretions.

Predominant Age: Reproductive (based on pathophysiologic changes).

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Based on underlying pathophysiologic changes.

Risk Factors: See individual pathologic conditions.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Spontaneous, continuous, or intermittent release of fluid from one or both breasts that may be milky, bloody, serous, serosanguineous, or cloudy; most physiologic discharge is white or green, clear, or yellow; serosanguineous or bloody nipple discharge is associated with malignancy in 7% to 17% of cases, but the color or clarity of the fluid cannot diagnose or rule out carcinoma.

DIAGNOSTIC APPROACH

Workup and Evaluation

Laboratory: Cytologic evaluation of the nipple discharge is associated with a false-negative result rate of almost 20% and is therefore of little value. A simple fat stain of the discharge confirms the physiologic character of the discharge (milk).

Imaging: Ductogram or galactogram may be diagnostic; mammography may be of assistance in evaluation. Ductoscopy has been advocated but does not have widespread availability or acceptance.

Special Tests: Surgical excision of the involved duct may be required for diagnosis and treatment. Approximately 25% of patients who undergo operations are found to have a malignancy.

Diagnostic Procedures: History and physical examination often differentiate between physiologic discharge and breast disease.

Pathologic Findings

Based on the pathophysiologic condition involved. Multiple papillomas or atypia suggest an increased risk for cancer.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.

Prevention/Avoidance: None.

Possible Complications: Failure to consider the possibility of significant disease may result in delay of diagnosis and treatment.

Expected Outcome: Surgical excision of the involved duct may be required for diagnosis and treatment.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy.

ICD-9-CM Codes: 611.79.

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