Navigating murky waters: a modern treatment algorithm for nipple discharge

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 ≥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.