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Abstract
Introduction/Background A good understanding of nipple discharge is vital, as it is common and may be the first sign of an underlying neoplasia.
FREQUENCY: 9% of breast clinic consultations
80% female experience/life
Palpation of the 4 quadrants: pencil sign, trigger point
NIPPLE FLUID SPONTANEOUSLY PRESENT without manipulation, different from
.NIPPLE SECRETION produced by breast manipulation:
(NORMAL).
To be significant: TRUE PERSISTANT, NON LACTATIONAL.
Methodology Clinical examination allows us to differentiate between three types of nipple discharge: physiological (serous, bilateral, multi-orificial and scanty), pathological (bloody or serous, unilateral and uni-orificial) or benign (greenish, thick, pauci-orificial). Physiological discharges are linked to the secretory nature of the mammary gland; benign discharges are often due to ductal ectasia; and, finally, pathological discharges may be the consequence of papillomas, atypical intraepithelial lesions, or in situ or invasive carcinomas.
Results Physiological and benign discharges require no special treatment. In the case of pathological discharge, however, an imaging work-up is required, including ultrasound with or without mammograms, possibly mammary magnetic resonance imaging (MRI) or galactography, and cytology of the discharge fluid. If a suspicious lesion is detected on imaging, a histological sample must be taken.
Conclusion The therapeutic management of discharges varies, ranging from abstention in the case of physiological or benign discharges to surgical treatment for intracanal or invasive epithelial lesions. In the case of pathological discharge, if no diagnosis has been established, selective pyramidectomy of the oozing duct is necessary to avoid overlooking a possible underlying cancerous pathology.
Disclosures The authors declare no conflict of interest
