Assessing nipple abnormalities among women who come for breast cancer screening at MAKCHS Pathology Department

Abstract

Background: The breast is a highly sensitive organ especially in the females. Many physiological and pathological processes can lead to visible morphological changes of the breast. Among these are the non-lump changes that may or may not occur simultaneously with a lump. The non-lump changes used are; nipple discharge, nipple retraction and inversion. These changes could be helpful in the early diagnosis of breast disease including breast cancer as they could be the only early indication of breast malignancy. Aim and Objective: To assess nipple abnormalities and their association with age as seen among women who present with abnormal breast changes. Methodology: This was a prospective laboratory based study conducted on 42 patients having at least nipple discharge (ND) and or nipple retraction (NR). Samples were picked both by imprint cytology for the discharge and FNA for patients who presented with lump changes in addition to ND and or NR. Slide samples were dry and air fixed, then stained with Diff Quik and Papanicolaou respectively. The slides were assessed for cytological abnormalities under X40 objective and the results entered into Excel and exported to SPSS version 20 for analysis. Results: Nipple discharge was the commonest non-lump change, affecting women between 16 years to 89 years. Thirty of the (71.4%) had ND. Twenty (47.6%) patients presented with clear ND, 5 (11.9%) with bloody ND, 4 (9.5%) with purulent ND and 1 (2.4%) presented with milky ND. One (3.33%) of the 30 women had both ND and NR occurring concurrently. Twelve (28.6%) of the women presented with NR out of which 1 (8.33%) presented with ND as well. Eighteen (42.9%) of the patients with nipple abnormalities had a malignant process, 15 (35.7%) had a benign process while 9 (21.4%) had infections. Conclusion: Though most of the patients who presented with nipple abnormalities had either a benign process or inflection, a significant percentage of these women had a malignant process. Recommendation: Patients with nipple abnormalities must be thoroughly examined, and triple assessment must be adhered to as some of these abnormalities may not present with a significant palpable lump.