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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Mar 1, 2018 06:36PM NSwrites wrote:

That makes sense. Thanks, Djmammo. I was able to express fluid at the appointment but they couldn't get the needle in. Perhaps the cold room played a factor. My doctor will not send me back for another one, nor for an MRI. I will push to see a specialist.

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Mar 27, 2018 06:45PM ConfusedZee wrote:

DJ - I recently had a spontaneous nipple discharge from my left Breast which was clear. I did a self exam and noticed an indentation on the lower part of the left Breast when my arms are raised. I had a scare 6 years ago, but it was a lump that turned out to be fibrocystic breasts. I have an appt with my obgyn Monday. What questions should I ask and should I persist for MRI?

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Mar 28, 2018 09:21AM djmammo wrote:

Tinydaisey7

I would see a doc at your first opportunity, either PCP, ObGyn, etc. doesn't matter who, just anyone who can examine your breasts and order some imaging. There are agencies in most states that will help with these kinds of expenses for people without insurance. Do this soon. Make sure you tell them about the nipple discharge in the past too.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 28, 2018 09:30AM djmammo wrote:

ConfusedZee

Clear and bloody are the two colors of discharge we worry about, though bloody more so. You should ask what they think is causing the discharge, but your doc will ask most of the questions like when it started, is it one sided, is it spontaneous, has there ever been any blood. May also ask you about current medications.

At this point I don't think insurance will pay for an MRI until mammo & ultrasound are performed. Papillomas are usually what causes breast discharge of the type described above and they can often be well seen and biopsied on US. If it cannot be located on US then I personally prefer a ductogram to an MRI for this but then again I have done so many of them (they are falling out of favor since they can be time consuming and it gets difficult to find someone who does them frequently enough). If the culprit is only a few millimeters in size it will be difficult to distinguish from all the other tiny white dots that make up an MRI of the breast.

Let us know what your doc says.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 31, 2018 10:35AM Deema_0 wrote:

after reading through this thread im super anxious. i now noticed that my right nipple has a clear to yellowish discharge when squeezed and it seems to be more than the left. Is this something I should go back to the dr for? Had a clear ultrasound in September and just met with breast surgeon in February. Scheduled for annual with my gyn in may. (Side note: I have major health anxiety!!)

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Apr 1, 2018 05:53AM djmammo wrote:

Deema_0

If this is a new symptom for you, your doctor(s) need to know about it and have the opportunity to request imaging for it. The cause of the discharge is often a very small growth in a duct that cannot be seen on routine mammograms. A careful US search is the first step in evaluation of nipple discharge. If you haven't read my inital post in this thread, go back and read that now for additional information.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Apr 6, 2018 09:08PM ConfusedZee wrote:

DJMAMMO - I wanted to give you an update, had my mammo and US. The mammo was clear per the radiologist, but she saw something in the ducts and referred me to the breast surgeon so he/she can try to squeeze some out? That’s what I was told. Your thoughts on the breast surgeon referral and next steps?

Thanks much!

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Apr 6, 2018 10:21PM djmammo wrote:

ConfusedZee

There is a test where some of that fluid is collected and sent to a lab for analysis, maybe that's what they were referring to.

Where I have practiced if we saw something in the duct that we thought was causing the discharge we would biopsy it under US. If it came back abnormal we would send them to the breast surgeon at that time. If we could not see anything on US we would do a ductogram. If the ductogram could not be done we would go with an MRI.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Apr 25, 2018 07:26PM MM350 wrote:

Hi I’ve been having a clear nipple discharge from one duct in one breast and have been itching and has been on going for 5 months...I went to dr, had mammogram it came back clear, no unusual microcalcification groupings so I let it go after a few months I went back to dr because I was still having discharge they did blood work which all came back normal (prolactin levels, thyroid, etc) so I asked dr what he thought was causing this and he said he thought I possibly have Intraductal Carcinoma and is sending me to a breast surgeon to do more testing...should I be worried

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Apr 25, 2018 07:56PM melissadallas wrote:

MM350, are you sure he didn't say intraductal papilloma

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor. Dx 5/20/2012, LCIS, Stage 0, 0/0 nodes

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