NIPPLE DISCHARGE

- Introduction

In Egypt, based on the updated statistics according to the World Health Organization (WHO) 2022 for breast cancer, there is 26 845 new case each year among females with a crude incidence rate of 51.1/100 000 normal population and an age standardized incidence rate of 55.4/100 000 normal population. Thus, according to these data, breast cancer is the most common malignancy among females representing 34.9 % of female cancers (13,14). Nipple discharge is the third most common breast symptom after pain and palpable lump (15). It is categorized as physiologic or pathologic.

Physiologic nipple discharge may be white, green, or yellow in color. It is typically non-spontaneous, bilateral, and occurs in multiple ducts (16). Several studies have revealed that it is mostly benign with no evidence of insitu or invasive carcinoma (17). Examples include premenopausal women experiencing milky nipple discharge unrelated to normal breastfeeding known as galactorrhea, as well as duct ectasia as a manifestation of normal involution of the breast with stagnant secretions that may accumulate (3).

Pathologic nipple discharge may be associated with benign or malignant causes. It is typically unilateral, spontaneous, originating from a single duct orifice, and is often clear or blood-stained (16). Patient demographics such as age, help determine the degree of suspicion of the pathologic nipple discharge. If associated with palpable abnormality, nipple eczema or retraction, diagnostic imaging should be considered (18). The most common cause of pathologic nipple discharge is papillomas followed by duct ectasia, postoperative fluid collection, and retroareolar needle biopsy. Breast cancer accounts for 5–15% of cases, the most common type being ductal carcinoma in situ (19).

Following a comprehensive clinical breast examination, often conducted by the referring physician or a board-certified breast clinician, the radiologist must demonstrate concordance between the imaging findings and the clinical data (1,2).