Spontaneous nipple discharge (SND) is the third most common symptom referred to breast clinics following palpable masses and pain.  Discharge accounts for 10% of surgical referrals. SND is a symptom of malignancy in up to 12% of breast cancers and requires appropriate investigation to differentiate malignant from benign diseases with a focused ultrasound and/or mammogram.  Patients with SND who have neither palpable masses nor evidence of disease on imaging have traditionally been investigated with galactogram and duct excision to prevent missing a diagnosis of cancer.  As imaging diagnosis has improved it has raised the question of how frequently breast cancer is diagnosed following microductectomy and whether the procedure remains necessary. The aim of this study was to determine the incidence of malignancy in women presenting with SND who underwent microductectomy after initial clinical and radiological evaluation.

A retrospective chart review was conducted for patients referred to our breast clinic for SND between 2009-2016. All patients who underwent microductectomy for SND were included in our study and their pathology reports were examined to determine the incidence of malignancy.

219 microductectomies were performed for women presenting with SND whose clinical and radiological work up was negative for abnormalities. Breast cancer was identified in 15% of patients: 3% invasive carcinoma (n=6) and 10% carcinoma-in-situ (n=22). The majority of women had benign pathology including intraductal papilloma 54% (n=119) or other (normal/inflammatory/hyperplasia/ectasia) representing 33% (n=71) of cases.

At our center women 13% of women presenting with SND who underwent a microductectomy procedure had malignant lesions, a rate higher than expected.  Patients with SND should continue to be evaluated with microductectomy to guide further management and prevent missed cancers.

Is Microductectomy Still Necessary For Breast Cancer Diagnosis?