Nipple Discharge as Presentation of Underlying Breast Disease at Alkindy Teaching Hospital, Interventional Study

Abstract

Background:- Nipple discharge is the third most frequent complaint of female patients visiting a breast clinic, it’s a common presenting finding that may be caused by an underlying intraductal pathology, hormonal imbalance or a physiologic event. Aim of the study:- Is to determine the most common type of nipple discharge and to assess the association between nipple discharge and breast diseases at Al-Kindy teaching hospital Baghdad / Iraq. Patients & Methods:-This is a descriptive study of patients who visited the breast clinic at Al-kindy teaching hospital over a period of two years 1st January 2018 to 31th of December 2019,all patients with nipple discharge included in the study. Full history, clinical examination, laboratory investigations and hormonal investigation (S. prolactin, TSH,T3,T4) was done for all patients. Radiological examination including ultrasound was done for all patients, Mammography for patients above 40 years and MRI for the patients presented with suspicious nipple discharge with normal U/S and mammography. Direct cytology from nipple discharge was done for all patients. Fine needle aspiration cytology (FNAC) or TRU-CUT biopsy and histopathological examination was don for patient presented with nipple discharge associated with breast lump. Results:-The descriptive study included (120) patients presented with nipple discharge, the age of patients range from (19 years – 70 years) with a mean age(39.3+ 13.5) years. Positive family history of breast cancer found in (7) cases (5.8%) and only (15)cases (12.5%) had previous breast surgery. The most common type of nipple discharge according to the type were the bloody nipple discharge found in (52) patients (43.3%), Breast lump was found in (48) cases (40%), also we had (32) cases(26.7%) with spontaneous nipple discharge. In (34) cases (28.3%) the nipple discharge from uni-ductal orifice. Regarding laterality of nipple discharge, (83)cases (69.2%) presented as unilateral, the abnormal nipple discharge are more common with benign (103) cases (85.8%) than malignant breast disease(17)cases (14.2%). The bloody nipple discharge was associated with malignant disease in (11) cases (21.1%). Regarding the histopathologicalc and cytological results of nipple discharge the most common result was duct papilloma (43)cases (35.9%). Conclusions:- Spontaneous bloody, unilateral, single duct discharge needs a work up and thorough evaluation, nipple discharge in most patients is due to benign causes.