الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Nipple discharge (ND) is the third most frequent complaint of patients visiting a breast clinic, being the presenting symptom in 4-7% of cases. Additionally, it accounts for 6-7% of breast surgical indications.
In addition, it has been questioned whether discharge colour correlates to histological diagnosis. Some authors reported higher malignancy rates in bloody ND, whereas others found no association.
Traditionally, pathologic ND is evaluated by cytological examination of fluid smears. Although there are additional diagnostic clues in a majority of cases. ND smears may detect malignancy reliably when other clues are absent.
Traditionally the management of pathological nipple discharge has caused somewhat of a diagnostic dilemma, with both physiological and pathological aetiologies proving difficulty to differentiate. However, application of the systematic and minimally invasive gold standard of Triple Assessment (combining the three modalities of radiology, clinical examination and cytological analysis) has enhanced both diagnostic speed and accuracy.
Physiological nipple discharge, often a feature upon breast manipulation (non-spontaneous), is typically considered bilateral and emanating from multiple ducts. It may present as one of a spectrum of colours ranging from milky-white to brown/black. In contrast, discharge suggestive of malignancy is typically spontaneous, persistent, unilateral and originating from a single duct as a serous or bloody exudate. Although nipple discharge is of benign etiology in approximately 90% of patients, some studies had reported 6-21% of patients to have an underlying carcinoma.
nipple discharge smearing and its cytological examination may had some complementary diagnostic value. Therefore, its routine use for detection of nipple discharge-related breast pathology should be reconsidered carefully. Nipple discharge cytology may usefully redirect patient management in some cases. nipple discharge cytology has been reported as highly specific (specificity range of 81-96%) screening tool in the detection of carcinoma amongst patients with nipple discharge.
The impact of the rising incidence of breast disease has led to the demand for diagnostic tests that are not only accurate but also quick, cheap and cost effective. For this reason the last decade has seen a large increase in the popularity of cytological techniques in the diagnosis of breast lesions. Whereas cytology of fine needle aspirates (FNA) has been extensively reviewed, there is much less information regarding nipple discharge cytology,which may reflect the fact that nipple discharge is a rare symptom presenting in only about 5% of patients attending symptomatic breast clinics.
The aim of work was to evaluate the benefit of routine cytology of nipple discharge in early diagnosis of breast diseases.
This study was carried out on 500 female patients presented with nipple discharge in the oncosurgery unit, department of general surgery, Suez Canal university hospital in the period from January 2012 to September 2013. Lactating females were excluded from the study. patients were followed up for a minimum of 3 months and a maximum of 18 months on monthly basis follow up of the discharge and follow up of the breast as regard appearance of any breast lump or any changes.
In the present study,the highest incidence (29.8%) of nipple discharge occurred in the age group 40-<50 years. Four hundred twenty nine cases were married. Meanwhile, 71 patients were single.
One hundred thirty nine patients were in the post-menopausal period. Pre-menstrual females were 361, irregular cycles were recorded in 54 patients. The majority of the patients had at least one baby, while only 14.2% of the females were nulliparous.
About half of the patients were using contraceptive methods; 160 patients were using IUD, 60 patients were using oral contraceptive pills, and 29 patients were on contraceptive injection. Only 2.6% of the female patients had a family history of breast cancers in their relatives.
Conclusion
(1) Nipple discharge in most patients is due to benign causes.
(2) As routine investigations, every woman presented with nipple discharge should undergo exfoliative cytology because it has a sensitivity of 66.67% and a specificity of 100%. Other investigations will depend upon type, laterality of the discharge, whether the discharge is uniorificial or multiorificial and associated with lump or not.
(3) One method of investigation is not sufficient for the diagnosis of the cause of nipple discharge even in the benign cases, but correlation between physical examination, radiological and pathological investigations must be present.
(4) Regular follow up of the patient is important whether the patient is managed conservatively or surgically to check the efficacy of the treatment.
(5) Positive risk factor include: higher age,postmenopausal female ,positive family history ,breast lump, skin ghanges, Spontaneous bloody or serous, unilateral, single duct discharge
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