Topic: Nipple Discharge

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Jul 29, 2017 07:43AM

Posted on: Jul 29, 2017 07:43AM

djmammo wrote:

from the American College of Radiology

"Nipple discharge is a common complaint that leads patients to breast imaging evaluation. At least 80% of women will experience at least 1 episode of nipple discharge during their reproductive years. Nipple discharge is the third most common breast complaint after breast pain and breast mass, with a prevalence of 4.8% to 7.4%, and accounts for 5% of all breast symptoms. It is categorized as physiologic or pathologic.

Pathologic nipple discharge tends to be unilateral, from a single duct orifice, spontaneous, and serous or bloodstained. Nipple discharge that exhibits any one of these features may be considered pathologic.

Physiologic nipple discharge tends to be bilateral, from multiple duct orifices, and white, green, or yellow in color. In a study by Goskel et al, nonspontaneous nipple discharge, which was frequently colored or milky, was differentiated from spontaneous nipple discharge, which was considered pathologic. In this study, none of the patients with nonspontaneous nipple discharge developed cancer on follow-up examination. In another study by Bahl et al, no in situ or invasive cancers were found in patients whose nipple discharge did not exhibit any of the pathologic features. If patient history and physical examinations demonstrate physiologic nipple discharge and routine screening mammography is up to date, no radiologic investigation is needed.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Dec 9, 2019 04:09PM kalicat wrote:

Currently have clear (sometimes looks goldish) nipple discharge out of my LEFT nipple, from one duct only. Blood test for thyroids and prolactin levels were both normal

The weird thing is, in my RIGHT breast there is a lump (4 o'clock) and I am having a mammo and ultrasound done on wednesday this week to look at that.

Could they be related, considering they're in two different breast?

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Dec 10, 2019 07:05AM moderators wrote:

kalicat, we're sorry you are here and worried, but wanted to say welcome to Breastcancer.org!

It sounds like two different conditions but we can't really answer your question so we would definitely recommend that you see your doctor, which you did, and we're happy they sent you to mammo and ultrasound. Please, come back to let us know how it goes tomorrow!

Best wishes,

The Mods

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Dec 10, 2019 08:34AM kalicat wrote:

Than you so much for the response. Here’s to hoping neither is serious. I will definitely update once I know what’s going on :)

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Jan 9, 2020 09:06AM hazelb712 wrote:

Hi Everyone,

I am 30 years old, unmarried, never pregnant and never breastfeeding.

I first saw a bloody discharge on my right breast last year on 9/22/2019, 10 days after a car accident, I went to urgent care and had a ultrasound, the result was unrevealing. The discharge stopped after that once.

I then had another bloody discharge with manual expression on 10/13/19 and then scheduled for diagnostic mammogram on 10/16, which were still unrevealing, with a BI/RADS 3. But they did say I had a dense breast.

A ductogram was taken on 11/7/19, they still said they were able to have a small spot discharge at 10:00 direction but no lesion/ objecting defect.

Then I was referred to see a breast suregon on 11/14, he referred for me for MRI, which I just took 01/08/2020, I have anxiety and I am stupid enough to believe that I can dodge a bullet with my head hiding.

The breast surgeon told me he would contact me a soon as possible once the result is available.

After the first time, all other bloody discharges were from manual expressions. Doctor told me to stop doing that, I would try my best to restrain myself.

I am from Asia so please pardon my English and my breast knowledge was so limited until I google/research recently. The more I visit different websites, the more scared I get.

Feeling is mixed, I want to get to the bottom of my answer but I guess all I can do is to pray.


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Jan 9, 2020 10:13AM moderators wrote:

Welcome, hazelb! We know that waiting is horrible and it's hard not to worry about it, but just know that you are not alone here in this wonderful Community. The next few days try to keep calm and busy, to keep yourself distracted and keep your mind off the worse.

Wishing you good luck with MRI results! Please keep us posted!

The Mods

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Jan 9, 2020 12:24PM hazelb712 wrote:

Thanks for the kind response.

I am actually in emotional turmoil right now, couldn’t go to work, cried whole night before and even during the MRI, the fear, and the uncertainty it will bring... I am really not a fighter type, but it is the first time I feel my health is out of my own hands.

Breast surgeon kept telling me to stop squeezing the nipple, but I couldn’t control myself from doing it after the first incident, so October and December incidents were all happened after nearly torture squeezes. embarrassingly, the doctor couldn’t get anything out during the two visits, and I was so awkward and thought if I need to see a shrink instead.

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Jan 9, 2020 01:38PM - edited Jan 9, 2020 01:57PM by hazelb712

Hi DJMammo, I keep looking at the results from my ultrasound, mammogram, and ductogram... couldn't figure out why the contrast couldn't be injected entirely for ductogram... is it the reason why I was pushed by my breast surgeon for a MRI because all other procedures were inconclusive? I have this really wonderful breast surgeon, he actually pushed me for doing MRI twice, first time I didn't listen and second time I followed his advices.

US BREAST RIGHT COMPLETE 10/9/2019 4:05 PM CLINICAL INDICATION: Bloody discharge for 10 days COMPARISON: None. TECHNICAL FACTORS: Real time scan of the right breast wasperformed. Four-quadrant evaluation was performed and evaluationof the retroareolar region. SONOGRAPHIC FINDINGS: RIGHT BREAST: There is no evidence of a cyst or mass. This is anegative examination. IMPRESSION:Negative examination. BI-RADS: 0 - Incomplete.

MAMMOGRAM DIAGNOSTIC RIGHT DIGITAL 10/16/2019 12:22 PM CLINICAL INDICATION: Parenchymal asymmetry. Previous nippledischarge which has resolved COMPARISON: None. TECHNIQUE: right digital diagnostic mammogram images wereobtained. FINDINGS: The breast tissue displays scattered areas offibroglandular density. There is no new dominant mass, architectural distortion, clusteredmicrocalcifications or other mammographic evidence of malignancy. There is mild right upper outer quadrant parenchymal asymmetry IMPRESSION:Mild right upper outer quadrant parenchymal asymmetry. Likelybenign. BI-RADS: 3

Right breast ductogram. INDICATIONS: Right breast discharge. Radiologist wore sterile attire. This included a cap and face/eyeshielding.Radiologist's hands were scrubbed with Triseptin solution. Handsallowed to completely dry. Sterile gloves were worn. The patient's skin was scrubbed with Chlorhexidene gluconate. Theskin prep agent was allowed to completely dry.Insertion site: Right nipple. TECHNIQUE: After informed consent was obtained, the skin aroundthe right breast was cleaned and draped and prepped in usualsterile fashion. Using manual technique, a small partiallydischarging duct was noted at the 10:00 position. A small amountof brownish discharge was seen. Using a sialography catheter,attempts were made to cannulate the discharging duct. Thedischarging duct was partially cannulated and the patient hadinjection of 1 cc of Omnipaque 350 and mammogram was performed. FINDINGS: There is partial extravasation of contrast outside ofthe duct and the discharging duct is only opacified forapproximately 8 to 9 mm. No obstructing lesion is seen. No fillingdefect is identified. At conclusion, results were reviewed with the patient. There areno immediate complications. IMPRESSION:1. Small discharging duct at 10:00 is identified. Using asialography catheter, the discharging duct was partiallycannulated with retrograde injection identifying 8 to 9 mm ofperiareolar duct with no suspicious filling defect identified.
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Jan 9, 2020 02:16PM djmammo wrote:

hazelb712

Papillomas are most often the cause of bloody discharge and are not visible on mammo unless calcified also they are inconsistently seen on US. From the description it sounds like the ductogram was unsuccessful. The cannula did not go all the way in and the contrast leaked out of the duct which at least in part would keep the duct from being filled with contrast. Since the discharge was brown and not red/bloody we cant be sure it was in the correct duct. The only exam left would be the MRI but often the papilloma is so small it is difficult to identify on those images. Let us know what they find.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 9, 2020 04:18PM hazelb712 wrote:

Hi DJMAMMO,

thanks for your response. But when I went to the urgent care, the doctor tested that the discharge contains blood, that’s why she referred me to see a breast surgeon and ordered a ductogram. if the ductogram is unsuccessful, why the radiologist still said that “ No obstructing lesion is seen. No filling defect is identified” ? I think I am having panic attack now, couldn’t really functioning at all, crying all the time and after googling so many websites for different types of breast cancer, I also feel pain from the left breast. I heard there are a lot of cases that the bleeding breast is ok but the non-bleeding one has problem.

One thing I should mention was I keep pressing the nipple really harsh and it’s almost a daily torture for me to see if there are more blood coming out, but when I was at the breast surgeon’s office, he couldn’t get the bloody discharge out anymore. Should I stop pressuring my nipple?

thanks again


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Jan 9, 2020 04:38PM djmammo wrote:

hazelb712

STOP SQUEEZING. Squeezing can cause bloody discharge so it answers no questions. If you are determined to keep testing, press around the areola away from the nipple as if it were a clock face from 12, to 1, to 2 etc and note where you are pressing when the discharge occurs. Give this info to the next ultrasound tech.

"...if the ductogram is unsuccessful, why the radiologist still said that " No obstructing lesion is seen. No filling defect is identified"

Radiology reports are very specifically worded. It does not say there is no abnormality, it says no abnormalities were seen. There is a difference.

There is no reason to panic at this point since, although they need to be removed, the vast majority of papillomas are benign.

If it is upsetting you, stop Googling.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

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