Posted on: Jul 29, 2017 11:43PM
Posted on: Jul 29, 2017 11:43PM
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.
Apr 29, 2018 06:04AM b-a-p wrote:
I'm hoping someone could shed some light. Really hoping to get some sort of reply.
I have been having pain in one area of my breast constantly for 2 years. Tender to touch. But more recently I have been having serous nipple discharge (looks like cooking oil ) - sometimes it looks blood stained . It used to just be provoked and only came out when expressed. Now I'm finding it in my bra and shirts.
1 year ago I had an US that showed nothing except my 13 year old fibroadenoma that is stable.
8 weeks ago I saw a surgeon (before it became spontaneous and occasionally blood tinted ), who told me that it was normal and a majority of women could express this kind of discharge , and if I tried hard enough my other breast would have the same fluid (I've tried , it doesn't ). All she did was a clinical breast exam. I have all the red flags to have atleast some sort of follow up with tests : unilateral, watery, serous, and occasionally bloody, one pore , spontaneous and provoked , constant .
Where I live it's so hard to see a surgeon for this kinda thing and I know if I want to see her again, I'll need re referral if my dr will send one and see if he will even follow up or give me the "it's normal speech " again.
I am 30 so I feel like I'm being brushed off due to age and lack of major family history of B/c. And I'm not totally convinced that it's BC but I know whatever it is isn't normal and I shouldn't have to live with "it's normal to have discharge , it's normal for your boob to hurt 24/7"
Does anyone have any insight ?
Please and thanks
Aug 17, 2018 09:37AM fiveinthenest wrote:
6 days ago on my 45th birthday (Friday, aug 10) I woke up after sleeping on my stomach with very sharp constant nipple and areola pain on my right breast. I pressed the nipple and a long strand of thick yellowish discharge cans out of one duct on my nipple and a tiny bead of bright red blood cane out of a duct next to it. I immediately called my doctor who got me in for an exam on Monday. She ordered diagnostic mammogram for tomorrow. I still have pain in nipple and areola but not as strong. There is a lot of pain in the area under my breast area and everything feels swollen and there are parts of my breast that feel very very tender and more lumpy than usual. I have extremely large breasts that are very dense (I have i cups) and was diagnosed with a benign fibroadenoma in nov 2015 on the other breast. I have no other skin changes in that breast with the current pain except for one pimple-like dot that is red. No itchiness, redness, just extremely painful skin and the Montgomery glands on the areola are VERY painful to the touch. No fever. I have had no discharge spontaneous or otherwise since last Friday.
I'm of course so incredibly anxious worried about IBC or any other kind of malignancy. Could this be an infection? My whole breast is painful but not red. I started my period 4 days ago but the hormonal tenderness is usually gone by the 1st or 2nd day.
What questions should I ask at the breast center tomorrow? Should I make sure they do US?
Thank you! Freaking.
Jan 8, 2019 01:31AM - edited Jan 8, 2019 02:48AM by Jov016
I've read a few articles about nipple discharge and but I'm still a little bit worried. When I got home from work and changed clothes, I noticed that my right breast nipple and areola have a different shape after removing my bra. I then examined my nipple and saw a very tiny white/yellowish discharge on top of my right nipple. After I wiped it and tried to squeeze my nipple to see if any discharge will come out, nothing came. Im not sure if this is due to hormonal change as I have read before. I will be having my period by next week so I was thinking it might be because of it. Also both of my breast are a little tender due to PMS. Im 30 yrs old and never been pregnant. No lumps on my breast.
I will be having my check up aswell tomorrow just to see if my doctor will advise me any lab exams will be required.
Also Im not sure if it also a factor that I am on a keto diet trying to lose weight.
Feb 13, 2019 12:49PM - edited Feb 16, 2019 07:31AM by Hopingitsbenign
Hi DJMammo, I'm 54 years old with extremely dense breasts. I went for my routine mammogram and ultrasound last week and after my mammogram, the tech noticed blood on the plate. I've never had bloody discharge before!! A couple of years ago I had one incident of greenish discharge after my mammogram (I think it was from the same duct), but never anything spontaneous or bloody. I go to a wonderful breast imaging center (the oldest one in the country!), so they are well equipped. After seeing the blood, the tech immediately informed the radiologist who immediately ordered a ductogram. They completed that and the doctor saw some small filling defects. So they rushed me right into the biopsy room while the dye was still in my breast. The doctor performed a core needle biopsy followed by my regular ultrasound (which the radiologist did herself). My mammogram and ultrasound were normal. She told me she suspected the biopsy to show Papillomatosis or possibly hyperplasia or DCIS. She mentioned debris but didn't think it would cause multiple filling defects. Anyhow, she called yesterday... the biopsy showed no abnormal cells. It only showed fibrocystic changes, inflammation and duct Ectasia (I've seen that on my ultrasound report before). I was so relieved... until the doctor told me she wants me to have an mri next week - if that is normal, she'll be happy. If it shows something I'll need another biopsy and possible duct removal. I asked if it's possible she missed the area during the biopsy. She said she biopsied the area of the bigger filling defect, but not the smaller ones. I heard the gun go off a lot so I think she was pretty thorough. She also sent smears of the bloody discharge to the lab, it was benign. My question is... is it possible for fibrocystic changes or duct Ectasia or debris to show up as multiple filling defects? What else could cause filling defects with a normal biopsy? Could they be caused by little clots of blood... maybe the mammogram compression ruptured a capillary or cyst? I haven't bled since the mammogram. I never bled before and haven't bled since. I'm confused and worried. One interesting side note... I had mastitis in my other breast when I was 48. That was scary and bizarre. I hadn't breastfed in 4 years at that point. Maybe I'm prone to clogged ducts? That's my only unusual breast history. Thank you for your time.
Feb 14, 2019 03:25AM djmammo wrote:
Bloody discharge is the one we worry about most, followed by clear discharge. White, green, green/blue, yellow etc we don't worry about. Also to be worrisome it should also be spontaneous, unilateral, and from only one duct opening. Squeezing the nipple to elicit discharge can cause bleeding and give you a false positive for bloody discharge. Lab work is usually done when it is milky white and bilateral to check your prolactin level.
Bloody discharge is usually from a small growth in the duct that can be seen on US and MRI if it is big enough. For my money a ductogram (galactogram) has the best odds of identifying a nodule in the ducts if the criteria in the paragraph above are met.