scholarly journals Predicting Patients Found to Have Malignancy at Nipple Duct Surgery

Breast Care ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 491-497
Author(s):  
Nour Alshurbasi ◽  
Christopher W. J. Cartlidge ◽  
Stanley R. Kohlhardt ◽  
Sirwan M. Hadad
Keyword(s):  
Malignant Disease ◽  
Ductal Carcinoma ◽  
Nipple Discharge ◽  
Benign Disease ◽  
Presenting Symptoms ◽  
Benign Pathology ◽  
Fibrocystic Change ◽  
Ductal Hyperplasia ◽  
Malignant Lesions ◽  
Duct Excision

Introduction: The unexpected diagnosis of breast cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, pre-operative diagnosis of malignancy still evades us. The aim of this study was to review the pathological findings of total duct excision and microdochectomy with reference to pre-operative symptoms, ultrasound, or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods: Data were collected retrospectively of all patients who underwent total duct excision surgery in a single centre (2011–2017). Pre-operative demographics, symptoms, and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data were available for 211. Median age was 53 years. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10%) had “risk” lesions (papilloma with atypia, atypical ductal hyperplasia), and 15/211 (7.1%) had malignancy (ductal carcinoma in situ). Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1). 71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7%) had “risk” lesions, and 6/71 (8.5%) had malignant lesions. 83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk, and 10/83 (12%) malignancy. 38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk, and 2/38 (5.3%) malignant lesions. ­Conclusion: Neither imaging nor presenting symptoms correlate with the likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.

scholarly journals Duct Excision is Still Necessary to Rule out Breast Cancer in Patients Presenting with Spontaneous Bloodstained Nipple Discharge

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
R. E. Foulkes ◽  
G. Heard ◽  
T. Boyce ◽  
R. Skyrme ◽  
P. A. Holland ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Malignant Disease ◽  
Nonoperative Management ◽  
Nipple Discharge ◽  
Breast Clinic ◽  
Exact Test ◽  
Malignant Lesions ◽  
Duct Excision ◽  
Symptomatic Breast ◽  
Rule Out

Introduction. Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic. Benign and malignant causes of spontaneous nipple discharge continue to be difficult to distinguish. We analyse our experience of duct excisions for spontaneous nipple discharge to try to identify features that raise suspicion of breast cancer and to identify features indicative of benign disease that would be suitable for nonoperative management.Methods. Details of one hundred and ninety-four patients who underwent duct excision for spontaneous nipple discharge between 1995 and 2005 were analysed.Results. Malignant disease was identified in 11 (5.7%) patients, 4 invasive and 7 insitu, which was 10.2% of those presenting with bloodstained discharge. All patients with malignant disease had bloodstained discharge. Discharge due to malignant disease was more likely to be bloodstained than that due to benign causes (Fisher's exact test, 2-tailedPvalue = 0.00134).Conclusion. Our findings do not support a policy of conservative management of spontaneous bloodstained nipple discharge. Cases of demonstrable spontaneous bloodstained nipple discharge should undergo duct excision to prevent malignant lesions being missed.

Nipple Discharge as a Sign of Preneoplastic Lesion and Occult Carcinoma of the Breast: Clinical and Galactographic Study in 103 Consecutive Patients

1979 ◽  
Vol 65 (3) ◽  
pp. 317-324 ◽  
Author(s):  
Sergio Di Pietro ◽  
Gianfranco Coopmans De Yoldi ◽  
Silvana Bergonzi ◽  
Gianstefano Gardani ◽  
Roberto Saccozzi ◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Nipple Discharge ◽  
Diagnostic Value ◽  
Complete Resection ◽  
Preneoplastic Lesion ◽  
Carcinoma Of The Breast ◽  
Ductal Hyperplasia ◽  
Neoplastic Lesions ◽  
Sclerosing Adenosis

A clinical and galactographic investigation was carried out on 103 patients with hematic, serous-hematic, and serous nipple discharge. The age of the patients ranged from 18 to 72 years. A single papilloma was found in 20 cases, diffuse papillomatosis in 2 cases, atypical ductal hyperplasia in 8 cases, and ductal carcinoma in 4 cases (3 of these were infiltrating and 1 was noninfiltrating associated with a diffuse papillomatosis). Mammography gave no indications of carcinoma in any of the 4 cases. In the remaining 49 patients, pictures of ductal hyperplasia, periductal mastitis or sclerosis, sclerosing adenosis, or ductal ectasia were observed. The various types of lesions were often associated. Lacunae, stenosis, or occlusion of the ducts, evidenced by galactography, correlated well with the histologic findings of proliferative lesions of the ductal epithelium. Nevertheless, in practice, it should be the type of discharge that indicates surgery rather than galactographic or cytologic data, which appeared to have little diagnostic value. The frequency with which preneoplastic (or limit) lesions, and also nonsuspect carcinomas were found in patients with a significant nipple discharge confirm the importance of this symptom for a secondary prevention or early diagnosis of mammary neoplastic lesions originating from galactophorous ducts. Finally, complete resection of the galactophorous ducts must be considered as the best treatment in all patients with a suspicious nipple discharge that requires surgery.

Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings

2021 ◽  
Vol 94 (1120) ◽  
pp. 20201013
Author(s):  
Naziya Samreen ◽  
Laura B Madsen ◽  
Celin Chacko ◽  
Samantha L Heller
Keyword(s):  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Nipple Discharge ◽  
Breast Mri ◽  
Breast Masses ◽  
High Negative Predictive Value ◽  
Pathologic Nipple Discharge ◽  
Initial Imaging ◽  
Duct Excision

Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56–61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget’s disease, ductal carcinoma in-situ and invasive carcinoma. MRI’s high negative predictive value of 87–98.2% is helpful in excluding malignant etiologies of PND.

Outcomes of Clinical and Surgical Assessment of Women with Pathological Nipple Discharge

2006 ◽  
Vol 72 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Hernan I. Vargas ◽  
M. Perla Vargas ◽  
Kamal Eldrageely ◽  
Katherine D. Gonzalez ◽  
Iraj Khalkhali
Keyword(s):  
Effective Means ◽  
Nipple Discharge ◽  
Imaging Studies ◽  
Predictive Values ◽  
Image Guided ◽  
Guided Biopsy ◽  
Mammary Duct ◽  
Ductal Hyperplasia ◽  
Duct Excision ◽  
Sensitivity Specificity

There is no consensus about the diagnostic approach to pathologic nipple discharge (PND). We hypothesize that lactiferous duct excision (microdochectomy) or image-guided biopsy are safe and effective means of diagnosis of PND. Eighty-two patients with PND underwent history and physical exam followed by breast sonography and mammogram. Image-guided biopsy was done if imaging studies were positive, whereas microdochectomy was done if normal. Discharge was unilateral (96%), bloody (79%), and spontaneous (62%). The sensitivity, specificity, positive and negative predictive values for the detection of neoplasia were 0.07, 1.0, 1.0, and 0.4 for mammography and 0.26, 0.97, 0.91, and 0.48 for sonography, respectively. Tissue diagnosis revealed papillary lesion (57%), mammary duct ectasia (33%), breast cancer (5%), and inflammatory/infectious (5%) causes. Hemorrhagic discharge associated with pregnancy or infections was managed successfully without surgery. After a median follow-up of 18 months, no PND recurrence was seen, but one patient developed cancer in a different location after diagnosis of atypical ductal hyperplasia. In conclusion, imaging studies provide confirmatory information and a biopsy target when positive. Negative imaging does not reliably exclude neoplasia or malignancy. Microdochectomy provides a sensible and effective approach in the workup of patients with PND.

scholarly journals Galactography Combined with Sonogalactography for Improving the Evaluation of Pathological Nipple Discharge

2020 ◽  
Vol 11 (1) ◽  
pp. 327
Author(s):  
Juan de Dios Berná-Serna ◽  
Florentina Guzmán-Aroca ◽  
César Leal-Costa ◽  
Miguel Alcaraz ◽  
Juan de Dios Berná-Mestre
Keyword(s):  
Gold Standard ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Nipple Discharge ◽  
Diagnostic Efficiency ◽  
Predictive Values ◽  
Malignant Lesions ◽  
Diagnosis Algorithm ◽  
Sensitivity Specificity

Diagnosing patients with pathological nipple discharge (PND) is controversial, and therefore a standardized diagnosis algorithm is needed. The objective of this study was to investigate the usefulness of galactography (GL) combined with sonogalactography (SGL) for the evaluation of PND patients. A retrospective study was conducted of 51 patients with PND who were evaluated with GL and SGL. The findings from the galactograms of the patients in this study were assigned to different categories of the Galactogram Image Classification System. Additionally, the sensitivity, specificity, and the positive predictive values and negative predictive values of the GL and SGL tests were calculated, considering the gold standard of pathology diagnosis. The results obtained show that GL combined with SGL improved the diagnostic efficiency of ductal lesions, especially for borderline and malignant lesions. Papilloma was diagnosed in 19 cases, and ductal carcinoma in situ in 8 patients. Conclusions: To the best of our knowledge, this is the first study in which the combination of GL and SGL improves the diagnostic efficiency of ductal lesions of patients with PND. A diagnosis algorithm is recommended for women with PND.

scholarly journals Clinical Significance of Mucin Extravasation in Breast Core Biopsy Specimens

1970 ◽  
Vol 2 (1) ◽  
pp. 15-21
Author(s):  
SM Khodeza Nahar Begum ◽  
Jara Lazaro Ana Richelia ◽  
Aye Aye Thike ◽  
Julian Teng-Swan Ho ◽  
Jill Su-Lin Wong ◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Mucinous Carcinoma ◽  
Statistical Correlation ◽  
Excision Biopsy ◽  
Medical College ◽  
Fibrocystic Change ◽  
Ductal Hyperplasia ◽  
Rare Lesion

Mucin extravasation (ME) refers to the presence of mucin pools in the breast parenchyma, usually resulting from ruptured ducts distended with luminal mucin. Extravasated mucin is usually seen along with cystically dilated mucin filled ducts or mucocele like lesions (MLL) of the breast. MLL is a rare lesion that may be associated with a continuum of benignity to invasive mucinous carcinoma. The purpose of this study was to document the spectrum of lesions that can be associated with ME in breast cores and to correlate with the histology in subsequent surgical excision. Thirty-seven cases with ME on image guided core biopsies were reviewed from our departmental files, and their radiologic histologic findings were noted. Twenty-six of them of them underwent subsequent open biopsies which forms the basis of this study. It was noticed that columner cell lesion (CCL) associated with mucocele like lesion (MLL) as an important finding in relation with atypia. This finding was significant regardless of their presence in calcified or non-calcified cores and also a very good statistical correlation was seen between the quantitative presence of CCL in the core and excisional biopsy diagnosis. This are support the need for excision biopsy for the cases presenting with ME in their cores. In addition, a multidisciplinary approach should also be taken for cases presenting with ME, MLL and CCL altogether in breast core biopsies even in absence of obvious cytological atypia. Key Words: Mucin ExtravasationL Columnan Cell Lesion (CCL); Mucocele Like Lesion (MLL); Fibrocystic Change (FCC); Atypical Ductal Hyperplasia (ADH); Ductal Carcinoma in Situ (DCIS) DOI: 10.3329/akmmcj.v2i1.7466 Anwer Khan Modern Medical College Journal 2011; 2(1): 15-21

scholarly journals Fibrocystic Changes of the Breast: Radiologic–Pathologic Correlation of MRI

2021 ◽  
Author(s):  
Angela I Choe ◽  
Claudia Kasales ◽  
Julie Mack ◽  
Mayyadah Al-Nuaimi ◽  
Dipti M Karamchandani
Keyword(s):  
Clinical Symptoms ◽  
Nipple Discharge ◽  
Premenopausal Women ◽  
Breast Cancers ◽  
Pathologic Correlation ◽  
Guided Biopsy ◽  
Mri Features ◽  
Fibrocystic Change ◽  
Ductal Hyperplasia ◽  
Mri Guided

Abstract Breast MRI provides high sensitivity but modest positive predictive value for identifying breast cancers, with approximately 75% of MRI-guided biopsies returning benign pathologies. Fibrocystic change (FCC) is a descriptive term used colloquially by many radiologists (and falling out of favor with many pathologists) to refer to several benign entities encountered in the breast. Many of the benign entities believed to comprise FCC can show enhancement on MRI. Recognizing the pathologic correlates of these enhancing lesions should help guide management after such a result on MRI-guided biopsy. Premenopausal women may present with clinical symptoms attributed to FCC, including pain, nipple discharge, breast lumps, or discrete masses. Benign entities associated with FCC include proliferative lesions such as usual ductal hyperplasia and sclerosing adenosis, and nonproliferative lesions including cysts, apocrine metaplasia, and stromal fibrosis. Fibrocystic change can be diffuse or focal. Diffuse FCC usually presents as non-mass enhancement (NME), often with persistent kinetics. Focal FCC can present as an irregular mass or focus with variable enhancement patterns including washout kinetics. Following a benign concordant MRI-guided biopsy result of one or more of the above entities, follow-up with MRI in 12 months is reasonable. Accurate radiologic–pathologic correlation can be achieved when careful review of histologic findings is carried out in the context of MRI features.

scholarly journals Benign and malignant lesions of the breast: clinico-pathological perspective from a government teaching hospital in West Bengal, India

2018 ◽  
Vol 5 (11) ◽  
pp. 3460 ◽  
Author(s):  
Saurav Sarkar ◽  
Arista Lahiri ◽  
Soumyajyoti Bandyopadhyay ◽  
Snehasish Das ◽  
Tamal Chakraborty
Keyword(s):  
Ductal Carcinoma ◽  
Benign Lesion ◽  
Malignant Lesion ◽  
Benign Disease ◽  
Breast Diseases ◽  
P Value ◽  
Histopathological Diagnosis ◽  
Age Group ◽  
Peau D’Orange ◽  
Malignant Lesions

Background: While breast cancer is one of the most commonly diagnosed cancer more than half of the women develop some benign disease of breast in their lifetime. The current study was conducted to describe the clinico-pathological findings associated with breast diseases and study their relationship.Methods: A record-based cross-sectional study was conducted on the samples of breast tissue obtained by fine needle aspiration cytology (FNAC) examination. The clinical variables like age, sex, presenting complaint, involved side (right/left/both) etc. were taken from the clinical notes sent, and nature of the aspirate, histopathological diagnosis, nature of the diagnosed disease (benign/malignant), and axillary metastasis were taken as variables from pathological examination.Results: The mean age of the patients was 33.49 years (±13.24 years) with majority belonging to 20-40 years. Among the 184 specimens examined, 94.57% belonged to female patients. The most frequent presentation was with lump (95.11%). Complaint arising out of right breast (47.83%) were higher compared to left breast (40.76%). Involvement of the supero-lateral quadrant was seen in 75.54%. In 30.44% of the cases the material was bloody or blood-mixed. Majority of the patients (86.41%) were diagnosed with benign disease commonest being fibroadenoma. Ductal carcinoma was the commonest malignant lesion. Younger age group, absence of bloody discharge and absence of peau d’orange were associated with benign lesion in a statistically significant way (p-value <0.001).Conclusions: In consonance with published literature the findings suggest association of older age group with malignant lesions. Blood-mixed aspirate, peau d’orange appear to be danger signs.

Amorphous/Indistinct Calcifications (Group)

2018 ◽  
Author(s):  
Lilian Wang
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Morphological Classification ◽  
Imaging Protocols ◽  
Fibrocystic Change ◽  
Ductal Hyperplasia ◽  
Management Recommendations

Amorphous calcifications are calcifications that are sufficiently small and/or hazy that a more specific morphological classification cannot be made. Historically, such calcifications were referred to as “indistinct” calcifications. The likelihood of malignancy and the management of amorphous calcifications largely depend on their distribution. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis with radiology–pathology correlation, and management recommendations for amorphous/indistinct calcifications in a group. Topics discussed include spot magnification views for characterization, role of distribution in BI-RADS assessment, and pathological entities, including fibrocystic change, milk of calcium, atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS).

scholarly journals Intraductal Proliferative Lesions of the Breast—Terminology and Biology Matter: Premalignant Lesions or Preinvasive Cancer?

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Leopoldo Costarelli ◽  
Domenico Campagna ◽  
Maria Mauri ◽  
Lucio Fortunato
Keyword(s):  
Ductal Carcinoma ◽  
Intraepithelial Neoplasia ◽  
Premalignant Lesions ◽  
Flat Epithelial Atypia ◽  
Low Grade ◽  
Usual Ductal Hyperplasia ◽  
Morphological Criteria ◽  
Ductal Hyperplasia ◽  
Malignant Lesions ◽  
Molecular Aspects

Morphological criteria for the diagnosis of intraductal proliferative lesions of the breast have been an object of research and much controversy, and its terminology is rather confusing. Knowledge of the molecular aspects of this disease probably necessitates further research to clarify if these entities can be identified as breast cancer precursors or as a malignant preinvasive disease. These issues are of great interest not only for their biological implications, but also to the clinician who must understand the disease and direct therapies. Molecular studies have shown that epitheliosis (usual ductal hyperplasia) is not monoclonal, while malignant lesions (atypical ductal hyperplasia, flat epithelial atypia, low-grade and high-grade intraductal carcinoma) constantly show these characteristics. These malignant lesions, classified with a DIN grading system (ductal intraepithelial neoplasia), are not obligate precursors of invasive ductal carcinoma and do not represent different evolving grades in a linear model of cancerogenesis. Breast cancerogenesis probably has different pathways with different morphologic precursors.

Sign in / Sign up

Export Citation Format

Share Document