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.
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
.
DOI: 10.16139/j.1007-9610.2019.03.014
[1] Orzalesi L, Aldrovandi S, Calabrese C, et al.Nipple discharge after nipple-sparing mastectomy: should the areola complex always be removed?[J]. Clin Breast Cancer,2011,11(4):270-272.
[2] Fisher CS, Margenthaler JA.A look into the ductoscope: its role in pathologic nipple discharge[J]. Ann Surg Oncol,2011,18(11):3187-3191.
[3] Dupont SC, Boughey JC, Jimenez RE, et al.Frequency of diagnosis of cancer or high-risk lesion at operation for pathologic nipple discharge[J]. Surgery,2015,158(4):988-994.
[4] Chang RY, Cheung PS.Nipple preservation in breast cancer associated with nipple discharge[J]. World J Surgery,2017,41(1):176-183.
[5] Ashfaq A, Senior D, Pockaj BA, et al.Validation study of a modern treatment algorithm for nipple discharge[J]. Am J Surg,2014,208(2):222-227.
[6] Chen L, Zhou WB, Zhao Y, et al.Bloody nipple discharge is a predictor of breast cancer risk: a meta-analysis[J]. Breast Cancer Res Treat,2012,132(1):9-14.
[7] Lee SJ, Trikha S, Moy L, et al.ACR Appropriateness Criteria® Evaluation of Nipple Discharge[J]. J Am Coll Radiol,2017,14(5s):S138-S153.
[8] Nakahara H, Namba K, Watanabe R, et al.A comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge[J]. Breast Cancer,2003,10(4):320-329.
[9] Ballesio L, Maggi C, Savelli S, et al.Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study[J]. Radiol Med,2008, 113(2):249-264.
[10] Mortellaro VE, Marshall J, Harms SE, et al.Breast MR for the evaluation of occult nipple discharge[J]. Am Surg,2008,74(8):739-742.
[11] Berger N, Luparia A, Di Leo G, et al.Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: a systematic review and meta-analysis[J]. Am J Roentgenol,2017,209(2):465-471.
[12] Manganaro L, D'Ambrosio I, Gigli S, et al. Breast MRI in patients with unilateral bloody and serous-bloody nipple discharge: a comparison with galactography[J]. Biomed Res Int,2015,2015:806368.
[13] Lubina N, Schedelbeck U, Roth A, et al.3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail[J]. Eur Radiol ,2015,25(5):1285-1293.
[14] Sanders LM, Daigle M.The rightful role of MRI after negative conventional imaging in the management of bloody nipple discharge[J]. Breast J,2016,22(2):209-212.
[15] de Paula IB, Campos AM. Breast imaging in patients with nipple discharge[J]. Radiol Bras,2017,50(6):383-388.
[16] Bahl M, Baker JA, Greenup RA, et al. Evaluation of pathologic nipple discharge: What is the added diagnostic value of MRI?[J]. Ann Surg Oncol,2015,22 Suppl 3:S435-S441.
[17] Louie LD, Crowe JP, Dawson AE, et al.Identification of breast cancer in patients with pathologic nipple discharge: does ductoscopy predict malignancy?[J]. Am J Surg,2006,192(4):530-533.
[18] Grunwald S, Heyer H, Paepke S, et al.Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to standard me-thods[J]. Onkologie,2007,30(5):243-248.
[19] Yilmaz R, Bender O, Celik Yabul F, et al.Diagnosis of nipple discharge: Value of magnetic resonance imaging and ultrasonography in comparison with ductoscopy[J]. Balkan Med J,2017,34(2):119-126.
[20] Saremian J, Rosa M.Solid papillary carcinoma of the breast: a pathologically and clinically distinct breast tumor[J]. Arc Pathol Lab Med,2012,136(10):1308-1311.
[21] Kawasaki T, Mochizuki K, Yamauchi H, et al.High prevalence of neuroendocrine carcinoma in breast lesions detected by the clinical symptom of bloody nipple discharge[J]. Breast,2012,21(5):652-656.
[22] Obedian E, Haffty BG.Breast conserving therapy in breast cancer patients presenting with nipple discharge[J]. Int J Radiat Oncol Biol Phys,2000,47(1):137-142.
[23] Cabioglu N, Krishnamurthy S, Kuerer HM, et al.Feasibility of breast-conserving surgery for patients with breast carcinoma associated with nipple discharge[J]. Cancer, 2004,101(3):508-517.
[24] Zhao S, Mei Y, Wang J, et al.Different levels of CEA, CA153 and CA125 in milk and benign and malignant nipple discharge[J]. PLoS One,2016,11(6):e0157639.
