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The diagnostic value of nipple discharge cytology: Breast imaging complements predictive value of nipple discharge cytology
Author(s) -
Kalu Ogori N.,
Chow Cassandra,
Wheeler Amanda,
Kong Christina,
Wapnir Irene
Publication year - 2012
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23091
Subject(s) - nipple discharge , medicine , cytology , intraductal papilloma , malignancy , occult , papilloma , radiology , biopsy , predictive value , mammography , surgical pathology , breast cancer , pathology , cancer , alternative medicine
Background Papilloma is the most common finding associated with pathologic nipple discharge. In the absence of breast imaging abnormalities, the incidence of occult malignancy is <3%. Objective To determine the predictive value of nipple discharge cytology in conjunction with breast imaging. Methods Retrospective review of 160 charts; inclusion criteria of clinically pathologic nipple discharge, subsequent excisional biopsy, and absence of palpable abnormalities. Nipple discharge cytology categorized as negative, atypical, suspicious, and papillary. Breast imaging was analyzed. Preoperative tests were correlated to final surgical pathology. Results 89 patients identified. Sixty‐five had positive cytology, with a false positive rate of 32.3%. They were associated with papillomas in 52%, benign non‐papillary in 33% and malignant lesions in 9% of cases. Nipple discharge cytology was positive in 69.6% of papillomas and 92% of atypical/malignant lesions; 30% had abnormal breast imaging and positive cytology. Nipple discharge cytology had a sensitivity of 74.5%, specificity of 30%, and positive predictive value of 68%. The positive predictive value increased to 85% with associated abnormal breast imaging. Conclusions Nipple discharge cytology is useful in evaluating pathologic discharge. However, negative cytology with negative imaging is not enough to avoid surgery in cases of suspicious clinical presentation. J. Surg. Oncol. 2012; 106:381–385. © 2012 Wiley Periodicals, Inc.