Materiały źródłowe

• #1 Workup and treatment of nipple discharge—a practical review – Stafford – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6921/html

  PND is a clinical diagnosis that warrants a thorough work-up, not only because of the risk of malignancy, but also because of the concern it causes patients. […] The risk of malignancy in patients who are evaluated surgically ranges from 5-23% of cases with predominantly ductal carcinoma in situ, but also invasive cancer. […] The rate of malignancy is also increased when PND is accompanied by radiologic or palpable findings on evaluation. […] Therefore, ruling out malignant lesions should be the primary aim in patients presenting with PND. […] Patients with PND who should still undergo surgical excision include those with imaging abnormalities, a personal or family history of breast cancer, BRCA1/2 mutations, or PND that persists for over 2 years. […] In these patients, and in patients who desire cessation of the discharge, ductal excision is typically both diagnostic and therapeutic.

• #2 Nipple discharge: Follow-up in operated versus non-operated patients – A single center experience

  https://www.oatext.com/nipple-discharge-follow-up-in-operated-versus-non-operated-patients-a-single-center-experience.php

  The prevalence of CIS (8%) and invasive cancer (2.5%) in this study is not differing from the prevalence otherwise described in the literature (5 to 15 %). […] Previous invasive cancer significantly increased the risk of invasive cancer/CIS as underlying cause of nipple discharge in both studies. […] The incidence of invasive cancer and CIS found in the follow-up period did not differ significantly between the two groups treated surgically or conservatively. […] Even if all of the above-mentioned examinations are inconspicuous, surgery probably should be offered patients with age above 50 years, presenting with recurrent bloody nipple. […] The specific study aims to identify risk factors for cancer has not been fully met, but the evaluation of current treatment strategy was satisfactory.

• #3 Role of immediate injection of methylene blue after fiberoptic ductoscopy in selective ductectomy for patients with pathological nipple discharge | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-025-13467-8

  Pathological nipple discharge (PND) is associated with malignancy. This study aimed to investigate the value of fiberoptic ductoscopy (FDS) and the feasibility of immediate injection of methylene blue after FDS to identify discharging ducts and intraductal lesions without overflow of methylene blue during surgery. […] The overall detection rate of malignancy was 14.0% (23/164). […] Statistical analysis revealed that patients exhibiting older age, menopause, positive MG, and bloody discharge had a higher propensity for malignancy (P<0.05). [...] Ductoscopic features such as multiple and distal lesions, irregular morphology and hemorrhage of the lesions, and roughness and stiffness of the ductal walls were associated with malignancy (P<0.05). [...] Immediate injection of methylene blue after FDS allows clear identification of discharging ducts and intraductal lesions without overflow of methylene blue. This approach may be useful in guiding selective ductectomy for the detection of early breast cancer.

• #4 Role of immediate injection of methylene blue after fiberoptic ductoscopy in selective ductectomy for patients with pathological nipple discharge | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-025-13467-8

  Our study demonstrated that multiple and distal lesions, irregular morphology and hemorrhage of the lesions, as well as the roughness and stiffness of the ductal walls may be more likely to be malignant (Table 3, P<0.05). [...] The relationship between the appearance of FDS and malignancy varies among different studies. In our study, patients with older age, menopause, positive MG, and bloody discharge were more likely connected to cancer (P<0.05), consistent with the former literatures. [...] For PND patients with negative US or MG, FDS can detect introductal lesions and provide a certain predictive value. The guidance provided by the immediate injection of methylene blue after FDS in selective ductectomy allows the direct visualization of the discharging mammary ducts and intraductal lesions, especially for multiple, non-elevated, and peripheral ones, without overflow of methylene blue. This technique may play an important role in detecting early breast cancer.

• #5 A Nomogram to Predict the Probability of Breast Intraductal Tumors in Patients with Nipple Discharge: A Real-World Study Based on Our 13-Year Clinical Experience

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7650034/

  Patients with the clinical characteristics of unilateral, bloody, single-duct, spontaneous discharge and a smooth ductal wall were more likely to have intraductal tumors by ductoscopy. […] Our nomogram can effectively predict intraductal tumors in patients with nipple discharge. […] The odds ratio (OR) was also calculated to analyze the risk of each factor. Univariate binary logistic regression analysis is presented in Supplemental Table 2. Discharge duration (OR, 1.92; 95% CI: 1.093.40; p=0.025), unilateral discharge (OR, 2.99; 95% CI: 2.004.47; p0.001), single-duct discharge (OR, 3.48; 95% CI: 2.454.95; p0.001), spontaneous discharge (OR, 2.41; 95% CI: 1.753.32; p0.001), red-colored discharge (OR, 12.29; 95% CI: 8.4317.92; p0.001), yellow-colored discharge (OR, 4.75; 95% CI: 3.316.81; p0.001), bloody discharge (OR, 10.07; 95% CI: 1.2084.58; p=0.034) and a smooth ductal wall (OR, 8.03; 95% CI: 5.8810.96; p0.001) were risk factors for intraductal tumors in patients with ND. […] This study, for the first time, established a model to predict whether a patient had intraductal tumors based on clinical manifestations worldwide.

• #6 Nipple discharge: Follow-up in operated versus non-operated patients – A single center experience

  https://www.oatext.com/nipple-discharge-follow-up-in-operated-versus-non-operated-patients-a-single-center-experience.php

  Patients with nipple discharge are often treated surgically and pose a diagnostic and therapeutic challenge. […] The objective of the present study was to investigate if clinical predictors of underlying malignancy could be identified. […] In the operated group, invasive cancer was found in 2%, and CIS was found in 9% of cases. […] A history of previous breast cancer significantly increased the risk of an underlying invasive cancer in nipple discharge patients (p 0.05). […] Current clinical stratification identifies patients with pathological nipple discharge requiring surgery, but over-treatment is a concern. […] According to existing literature, and partially supported by the current study findings, all women aged 50 years or more presenting with recurrent, bloody nipple discharge should be offered duct excision, which remains the diagnostic gold standard, especially in case of a medical history with previous breast cancer.

• #7 Nipple discharge: Follow-up in operated versus non-operated patients – A single center experience

  https://www.oatext.com/nipple-discharge-follow-up-in-operated-versus-non-operated-patients-a-single-center-experience.php

  The prevalence of CIS (8%) and invasive cancer (2.5%) in this study is not differing from the prevalence otherwise described in the literature (5 to 15 %). […] Previous invasive cancer significantly increased the risk of invasive cancer/CIS as underlying cause of nipple discharge in both studies. […] The incidence of invasive cancer and CIS found in the follow-up period did not differ significantly between the two groups treated surgically or conservatively. […] Even if all of the above-mentioned examinations are inconspicuous, surgery probably should be offered patients with age above 50 years, presenting with recurrent bloody nipple. […] The specific study aims to identify risk factors for cancer has not been fully met, but the evaluation of current treatment strategy was satisfactory.

• #8 A Nomogram to Predict the Probability of Breast Intraductal Tumors in | CMAR

  https://www.dovepress.com/a-nomogram-to-predict-the-probability-of-breast-intraductal-tumors-in–peer-reviewed-fulltext-article-CMAR

  Patients with the clinical characteristics of unilateral, bloody, single-duct, spontaneous discharge and a smooth ductal wall were more likely to have intraductal tumors by ductoscopy. […] Our nomogram can effectively predict intraductal tumors in patients with nipple discharge. […] The area under the ROC curve (AUC) was calculated to be 0.716, indicating good predictive ability. […] The tumor risk of patients was expressed by the following equation: ln(p/1p) = 0.583 a 1.162c b + 0.928 c + 0.504 d1 + 0.801 d2 + 0.657 d3 + 1.127 e – 1.918, where p represents the risk of tumor. […] The area under the ROC curve of the verification model using bootstrapping and external verification was 0.735 (95% CI: 0.6870.784) and 0.716 (95% CI: 0.6410.791). […] The decision curve showed that if the patients threshold probability was between 5% and 69%, using this model to predict intraductal tumors would give the patient more net benefits.

• #9 Prospective study of outcome in women presenting with nipple discharge – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7702320/

  In this study, 56 women who presented to the breast clinic with nipple discharge have been reviewed. […] Those women who did not have carcinoma detected at their initial presentation have been reviewed after a minimum of 5 years. None has gone on to develop breast cancer. We conclude that women with nipple discharge, but no positive findings on triple assessment, are not at an increased risk of the development of carcinoma. In addition, nipple discharge spontaneously resolves in 73% of women over a 5 year period.

• #10 Workup and treatment of nipple discharge—a practical review – Stafford – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6921/html

  While all patients previously underwent surgical intervention, conservative management with close follow-up, biannual US, and yearly mammogram can now be considered in select patients. […] Surgical resection is no longer recommended in patients with PND, normal imaging (mammography, US, and MRI), and no other suspicious findings. […] Since the risk of malignant lesions is low, and since the most common malignant lesions that are seen are typically low-grade DCIS or small invasive tumors, a consideration is that these patients forego surgery in favor of a two year follow-up regimen consisting of US and clinical examination every six months combined with annual mammography. […] Patients with PND for whom surgical intervention is still recommended include those with abnormal imaging findings and personal history or family history of breast cancer.

• #11

  https://link.springer.com/article/10.1007/s10549-021-06094-x

  Pathological nipple discharge (PND) is a common breast-related complaint for referral to a surgical breast clinic because of its association with breast cancer. […] The meta-analysis showed no significant difference in sensitivity between ductoscopy (44%) and MRI (76%) for the detection of malignancy in patients with PND. However, ductoscopy (98%) had a statistically significantly higher specificity than MRI (84%). […] Patients undergoing MRI are more often (false) positive which more often leads to duct excision surgery referrals compared to ductoscopy. This makes ductoscopy significantly more cost-effective compared MRI in patients with PND without radiological suspicion for malignancy. […] The current study showed that ductoscopy was more cost-effective for the detection of malignancy in patient with PND compared to MRI, regardless of the margin of error of the sensitivity (95% CI).

• #12

  https://link.springer.com/article/10.1007/s10549-021-06094-x

  The current study showed that ductoscopy was more beneficial (11.9%) and less costly (399.30) compared with MRI for the proper selection of PND patients for surgery. […] Therefore, even though a single MRI is less costly than a ductoscopy (822.13 vs. 1401.33, respectively), this analysis shows that it would still be considerably less expensive to use ductoscopy as a strategy in determining the need for surgery in this patient population. […] To conclude, this study is the first to directly compare the diagnostic performance of ductoscopy and MRI in patients with PND without radiological signs of malignancy. This study shows that ductoscopy has a significantly higher diagnostic accuracy in this patient population. This makes ductoscopy less costly and a more effective diagnostic tool in comparison with MRI to determine which patients finally require surgery to rule out malignancy.

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