Nipple discharge as only presenting symptom of breast cancer: a report of 75 cases

doi:10.16139/j.1007-9610.2019.03.014

Abstract

Abstract: Objective To investigate the clinicopathological characteristics including diagnosis and treatment of breast cancer with nipple discharge as only presenting symptom. Methods The data of 75 patients with breast cancer in our hospital from 2010 to 2018 with nipple discharge as only presenting symptom and mammography or ultrasound exams negative were collected. A retrospective analysis was done with clinicopathological data including imaging, therapy and prognosis. Results All cases were female with mean age (52.9± 13.4) (27-78) years old. Seventy-one cases (94.7%) had bloody nipple discharge. Of 22 cases who underwent enhancement magnetic resonance imaging (MRI), 17 cases (77.3%) were positive with BIRADS category 4 or higher. Sixty-five cases underwent intraoperative frozen section pathology, of which 38 (58.5%) cases were benign lesions and 27 (41.5%) cases were malignant lesions. Pathological types included ductal carcinoma in situ (n=29), solid papillary carcinoma (n=39), invasive ductal carcinoma (n=6), and invasive mucinous carcinoma (n=1). The largest diameter of focus including papillary carcinoma and in situ carcinoma was from 0.2 cm to 6.0 cm with the median of 1.0 cm and the diameter less than 2 cm in 58 (77.3%) cases. Estrogen receptor was positive in 68 cases, progesterone receptor positive in 62 cases and Ki-67 low proliferation (<
20%) in 71 cases. Eight cases underwent breast-conserving surgery, 67 cases with mastectomy. There were 59 cases with sentinel lymph node biopsy, and 5 cases with axillary lymph node dissection. No lymph node metastasis was detected. Totally, 11 cases did not receive axillary lymph node biopsy. Adjuvant endocrine therapy was given to 68 cases and adjuvant chemotherapy to 2 cases with invasive carcinoma. There was no recurrence nor metastasis case. Conclusions Bloody nipple discharge was found in most patients of breast cancer with nipple discharge as only presenting symptom. Enhanced MRI would have great help for diagnosis. Intraoperative frozen sections biopsy had less positive for diagnosis of breast cancer. Most pathological types were ductal carcinoma in situ and papillary carcinoma with lesions small. The good prognosis was seen due to early clinical stage and no axillary lymph node metastasis.

Key words: Nipple discharge, Breast cancer, Ductal carcinoma in situ, Papillary carcinoma, Magnetic resonance imaging

CLC Number:

R737.9

WANG Maoli, WU Kejin, MA Fenghua, DING Ang, YIN Chuyang, SONG Hui, SUN Jian, CHEN Hongliang. Nipple discharge as only presenting symptom of breast cancer: a report of 75 cases[J]. Journal of Surgery Concepts & Practice, 2019, 24(03): 242-248.

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