Wong Chung Justin E R E, Jeuriens-van de Ven Sjannieke A H, van Helmond Noud, Wauters Carla A P, Duijm Lucien E M, Strobbe Luc J A
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Faculty of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Breast J. 2016 Mar-Apr;22(2):202-8. doi: 10.1111/tbj.12544. Epub 2016 Jan 22.
Unilateral single-duct nipple discharge is associated with an increased risk for underlying breast malignancy. There is no consensus whether color of nipple discharge independently indicates the risk of malignancy. We sought to assess the relationship between the color of discharge and the risk of malignancy. Patients with unilateral single-duct nipple discharge without abnormalities on clinical and radiologic examination were included. Prior to diagnostic microdochectomy nipple discharge characteristics were registered. Multiple logistic regressions were performed to assess the relationship between color of nipple discharge and malignancy, corrected for age. During a mean follow-up period of 7.1 years we determined complication rate and false-negative rate of microdochectomy. A total of 184 patients were included (median age 53 years, range 19-84). Histologic examination revealed (in situ or invasive) breast carcinoma in 10.9% (20) of patients and high-risk lesions in 11.4% (21). Malignancy or high-risk lesions were found in 25% (OR: 1.37; 95% CI: 0.62-3.00) of patients with bloody discharge. Risk of underlying malignancy increased in patients >60 years (OR: 2.35; 95% CI: 1.14-4.83). Complication rate of microdochectomy was 2.7%. Single-duct, unilateral nipple discharge is a sign of underlying malignancy in a substantial proportion of cases. The majority of patients with unilateral single-duct nipple discharge, diagnosed with breast cancer, present with bloody discharge. However, the association between bloody nipple discharge and malignancy is not strong enough to distinguish high-risk patients. Therefore, invasive diagnostic procedures like microdochectomy should be offered to all patients with unilateral uniductal nipple discharge to search for underlying malignancy.
单侧单导管乳头溢液与潜在乳腺恶性肿瘤风险增加相关。乳头溢液的颜色是否能独立表明恶性肿瘤风险尚无共识。我们试图评估溢液颜色与恶性肿瘤风险之间的关系。纳入临床和放射学检查无异常的单侧单导管乳头溢液患者。在诊断性微导管切除术之前记录乳头溢液特征。进行多因素逻辑回归以评估乳头溢液颜色与恶性肿瘤之间的关系，并对年龄进行校正。在平均7.1年的随访期内，我们确定了微导管切除术的并发症发生率和假阴性率。共纳入184例患者（中位年龄53岁，范围19 - 84岁）。组织学检查显示10.9%（20例）患者有（原位或浸润性）乳腺癌，11.4%（21例）有高危病变。血性溢液患者中25%发现恶性肿瘤或高危病变（比值比：1.37；95%置信区间：0.62 - 3.00）。60岁以上患者潜在恶性肿瘤风险增加（比值比：2.35；95%置信区间：1.14 - 4.83）。微导管切除术的并发症发生率为2.7%。在相当一部分病例中，单导管、单侧乳头溢液是潜在恶性肿瘤的征象。大多数被诊断为乳腺癌的单侧单导管乳头溢液患者表现为血性溢液。然而，血性乳头溢液与恶性肿瘤之间的关联不够强，无法区分高危患者。因此，对于所有单侧单导管乳头溢液患者均应提供如微导管切除术等侵入性诊断程序，以寻找潜在的恶性肿瘤。
