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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Jan 31, 2020 06:02AM MelC66 wrote:

Thank you so muchfor the information. I just hate the wait 😟.

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May 28, 2020 09:32AM CalicoKitty2000 wrote:

djmammo, I finally was able to get an ultrasound of my nipple area for clear/yellowish nipple discharge. They didn’t want to do it because nothing was showing on my mammogram, but with a few appointments, I was able to get them to do it. This is the report, but now my surgeon called and said it needed to be removed. Also, the office lady is calling me saying it is very important that I come in right away. I am out of town and told her I would call next week when I know when I will be back and she acted like I needed to come in right away.I don’t understand the rush. Also, is there any research around just monitoring? I’d rather not have unnecessary surgery because of risks that come with surgery and it would cost me quite a lot of money with my high deductible. But I do have quite a bit of burning and sharp what seems to be cyclical pain, and at 42, I believe I am experiencing peri menopause. I just want to the right thing by weighing the risks. (The fibroidenomas have been there for about 10 years now)


Exam: E100764797 US BREAST LIMITED RT CLINICAL INDICATION: Nipple discharge, fibrocystic disease

Comments: Examination of the right breast at 6:00 and 10-11 o'clock positions shows hypoechoic sharply defined lesions presumably fibroadenomas that measures 2.1 x 1.9 x 1.3 cm 1.5 x 0.7 cm. There are horizontally placed and has sharply defined margins.

Examination of the breast at the 12:00 position, in the subareolar region shows a dilated duct that measures up to 3 mm. There is presence of a focal area of increased echogenicity in the duct suspicious for a possible intraductal papilloma.

IMPRESSION: 1. Dilated duct in the subareolar nn region at 12:00 position containing an echogenic area in the eight suspicious for presence of an intraductal papilloma. If needed, the duct and the lesion can be needle localized under ultrasound guidance.

BI-RADS CATEGORY 3

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May 28, 2020 01:11PM djmammo wrote:

CalicoKitty2000

All pappillomas are routinely removed due to a risk of malignancy. The gold standard for diagnosis is a ductogram. If there was blood flow within the intraductal finding on your study that is also a + sign for a pap. I dont see that mentioned in the report though. Debris can look like a nodule. Ask the radiologist to review the images and ask if there was blood flow in this finding on Doppler.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 28, 2020 09:31PM CalicoKitty2000 wrote:

Djmammo, thank you for the reply. I don’t really know how to talk to the radiologist since he never came to speak with me? Is it common to just call and ask? I logged into my electronic medical record to see the report. I do know that the tech took what seemed to be 1000 images of it. She said she was sorry she was taking so long and pushing so hard but she wanted to get really good images. I couldn’t watch the screen because it was giving me anxiety, but I did see her do the blood flow imaging, but I didn’t watch long enough to see it. Is surgery reall something that needs to be rushed? Or do I have time to let the hospitals get back to normal? I just didn’t understand her urgency when she called me. The surgeon left me a voice mail and just simply stated that it needed to be removed and he could remove the fibroidenomas at the same time.

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May 29, 2020 10:10AM djmammo wrote:

CalicoKitty2000

If it were me or my family I would want to know if there was blood flow in that finding as that is a hallmark of a papilloma. It sounds like they did the Doppler but it was not referenced in the report you posted. Call your doc and tell them you'd like the case reviewed and amended to include the Doppler findings. If there is no blood flow it might just be debris in the duct. They are more likely to comply if you don't schedule any procedures until that is done.

==========================

This next part is my personal opinion for what its worth.

If a good cosmetic appearance/result is important to you, consider having the procedure done by a fellowship trained breast surgeon as they usually have some cosmetic/plastic surgery training and make an effort to leave as little scarring as possible. Also ask if they feel its medically necessary to have the FA's removed as this may cause further disruption of the breast's appearance. If the FA's are causing symptoms and you want them out, that's a different story, and is your choice.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 29, 2020 11:58AM - edited May 29, 2020 11:58AM by CalicoKitty2000

Thank you for all the information. Would debris cause consistent nipple discharge? The first instance was late February on the first day of my period, it was spontaneous and clearish/yellowish. Then I messed around with it so much, it bled. The it cleared back up to clear/yellow. I can push down on one spot in particular on the nipple and make it consistently come out.

I will call and ask for the Doppler imaging. Are there other less invasive tests could I ask for?

This surgeon removed my first fibroidenoma and did a good job. I'm not as worried about appearance as I am about just being healthy.

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May 29, 2020 04:09PM djmammo wrote:

CalicoKitty2000

The place you pressed is where the papilloma is. Does that spot correspond to the location of the US finding? Show that spot to the surgeon. The Doppler is the blood flow eval done at the time of your ultrasound already, you just want to know what it showed.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 29, 2020 04:33PM CalicoKitty2000 wrote:

Yes the spot corresponds, I showed the US tech where to start based on that.

I knew what you meant on the Doppler, I meant is there any other non-invasive tests I should ask for before considering surgery

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Jun 28, 2020 05:23PM stangin wrote:

Hi, new here. Seeking reassurance as I am not feeling it from the health people. I am almost 52. Since last quarter 2017 have had clear, one duct, nipple discharge in left breast. Have dense breasts. No blood or any other color. When rubbed between fingertips, fluid very very slightly sticky. Expels on its own as if something is full. Would not amount to a teaspoon, probably. First mammo said to watch, follow up in 6 mos. Next one I asked technician what this is... saw a doctor. No answers but she ran me thru a digital mammo?, ductogram, MRI, ultrasound, and ultrasound biopsy / titanium marker. Was told by technician it was benign but not what it was, what was going on. Doc said could do surgery, but may lose feeling in nipple. Like if I wanted surgery??? Didn't explain what was happening or going on - I asked. Not one to jump on having surgery. Heard or read lesion in medical reports. Heard hormonal related?? The rest of the report is not in "English" to me. Skipped 6 mos followup in late 2018 - changing insurance and money issues after having all of those other tests. Thought for a minute the biopsy created scar tissue to close up duct and leak. Covid happened on year since last mammo. Haven't scheduled any yet. Discharge did slow down or pause entirely during Covid timeframe. Recently noticeable again but not as much as before the tests. After reading thru here, still confused. Want to gain knowledge before I go back in for mammo...... as it is close to 3 years since it started. Thanks in advance.

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Nov 24, 2020 10:17PM Tuc wrote:

Hello,

I have been experiencing unilateral spontaneous serous/bloody discharge for a few years. I joined this breast cancer.org site in March/2017. I have (breaking rules)posted a picture of the problem breast. I will not try to post picture again. I do hope that my breast health concerns will be found to be benign. The latest primary( non-profit) asked me a few months ago if my discharge had been seen under a microscope. I told them no. In April or May of this year I developed a hard swollen parotid gland in my neck--- one side only. I had a diagnostic mammogram and ultrasound in Nov. I got a letter in mail stating there was an abnormality seen and that I needed a biopsy.( My past imaging pointed out dense breast tissue, fibroadenoma microcalci., Hypoechoic--" what is that") can't recall anything about bi rad. I have been feeling very unwell for a few years. I had a hysterectomy in 2012-- fibroids(bled Alot)I am experiencing shortness of breath, cough /rash that won't resolve after medication. I have experienced other symptoms. I will recall to new primary Dec 3. Wish me luck--- that after about 13 yrs of symptoms ramping up that I will receive the correct diagnosis. My mother died of colon cancer 61 yrs old. I will be 59 in summer. Saying all this-- because---there is so much about what I am going through that so far-- no answerz.

Thank you for listening,

Tuc.


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