Department of Breast & Endocrine Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Surgeon. 2010 Oct;8(5):252-8. doi: 10.1016/j.surge.2010.03.005. Epub 2010 May 13.
Nipple discharge accounts for up to 5% of referrals to breast surgical services. With the vast majority of breast carcinomas originating in the ductal system, symptomatic dysfunction of this system often raises disproportionate clinical concern. The aim of this study is firstly, to evaluate the clinical importance of nipple discharge as an indicator of underlying malignancy and secondly, to assess the diagnostic application of duct cytology in patients presenting with nipple discharge.
We performed a retrospective analysis of all patients presenting with nipple discharge as their primary symptom to the symptomatic breast unit at a tertiary referral center over a 30-month period (n = 313). The Hospital Inpatient Enquiry (HIPE) System and BreastHealth database were used to identify our study cohort. Parameters evaluated included patient demographics, clinical presentation, clinical evaluation, radiological assessment and histological/cytological analysis.
Three-hundred and thirteen patients presented with nipple discharge as their primary complaint. Invasive breast carcinoma was diagnosed by Triple Assessment in 5% of patients. 24% of patients presenting with nipple discharge underwent nipple aspiration and cytological analysis. Duct cytology was diagnostic of the underlying breast carcinoma in 50% of triple assessment diagnosed carcinoma. Four risk factors were identified as having a significant association with breast carcinoma, these included (a) age >50 years (p < 0.0001), (b) bloody nipple discharge (p < 0.008), (c) presence of a breast lump (p < 0.0001) and (d) single duct discharge (p < 0.006).
Nipple discharge is a poor indicator of an underlying malignancy. Use of nipple aspiration and duct cytology for the assessment of nipple discharge is of limited diagnostic benefit. However, by utilizing the systematic, gold standard approach of Triple Assessment (clinical, radiological and cytological evaluation), the risk of underlying carcinoma can be accurately defined.
乳头溢液占乳房外科就诊的 5%。由于绝大多数乳腺癌起源于导管系统，该系统的症状性功能障碍常引起不成比例的临床关注。本研究的目的首先是评估乳头溢液作为潜在恶性肿瘤的指标的临床重要性，其次是评估乳头溢液患者中导管细胞学检查的诊断应用。
我们对 30 个月内（n=313）因乳头溢液作为主要症状就诊于三级转诊中心症状性乳房科的所有患者进行了回顾性分析。使用医院住院查询（HIPE）系统和 BreastHealth 数据库来确定我们的研究队列。评估的参数包括患者人口统计学、临床表现、临床评估、放射学评估和组织学/细胞学分析。
313 例患者因乳头溢液作为主要主诉就诊。三阴性评估诊断出 5%的浸润性乳腺癌患者。24%的乳头溢液患者行乳头抽吸和细胞学分析。三阴性评估诊断的乳腺癌中有 50%的导管细胞学诊断为乳腺癌。有四个危险因素与乳腺癌有显著相关性，这些因素包括（a）年龄>50 岁（p<0.0001），（b）血性乳头溢液（p<0.008），（c）乳房肿块（p<0.0001）和（d）单根导管溢液（p<0.006）。
乳头溢液是潜在恶性肿瘤的不良指标。乳头溢液评估中使用乳头抽吸和导管细胞学检查的诊断益处有限。然而，通过使用三阴性评估（临床、放射学和细胞学评估）的系统、金标准方法，可以准确定义潜在的乳腺癌风险。
