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Am J Surg. 2007 Dec;194(6):850-4; discussion 854-5.

Navigating murky waters: a modern treatment algorithm for nipple discharge.

Author information

1
Department of General Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. gray.richard@mayo.edu

Abstract

BACKGROUND:

Many women with nipple discharge undergo operative duct excision with few actually having carcinoma.

METHODS:

We reviewed all patients with nipple discharge at our institution from 2001 to 2005. Clinical findings were analyzed to determine an appropriate treatment algorithm.

RESULTS:

Nipple discharge was present in 204 patients. Carcinoma was identified in 7 patients (3% of all, 9% of those undergoing biopsy). Age > or = 50 years, abnormal mammography, and abnormal sonography were the only significant predictors of carcinoma. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram, the carcinoma risk was 3%. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram and subareolar ultrasound, the carcinoma risk was 0%.

CONCLUSIONS:

Patients with nipple discharge can be divided into risk groups by combining clinical and radiologic findings. Low-risk patients can be offered close clinical follow-up rather than operation. A recommended management algorithm is presented.

PMID:
18005783
DOI:
10.1016/j.amjsurg.2007.08.027
[Indexed for MEDLINE]

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