Cytological evaluation of nipple discharges among symptomatic patients who attended FNAC Clinic of Pathology Core Laboratory Makerere University

Abstract

Background: Nipple discharge (ND), refers to a secreted fluid from the breast and it is the third most common breast disease symptom and complaint following mastaglia and breast lump. Its most often associated with a benign process though can be malignant in some cases that cause it. Cytological examination of nipple discharge smears has been considered for a long time as a routine and useful non-invasive test for studying breast diseases most especially those presenting with no palpable mass. Differentiating between abnormal nipple discharges which result from physiological and benign causes from those secondary to a malignancy macroscopically is a bit difficult and quite challenging but a cytological examination gives useful information in evaluation and differentiation.

Aim and objective: To cytologically evaluate nipple discharge among symptomatic patients with a breast abnormality presenting exclusively with nipple discharge.

Methodology: This was a retrospective cross-sectional laboratory-based study of all patients presenting with a nipple discharge as a primary symptom with no palpable mass to the FNAC clinic of the pathology laboratory at college of health sciences Makerere university located at Mulago-Kampala over a period of 10years from January 2008-December 2018 (n=73). Patients' medical records and their respective smear slides were retrieved and examined respectively. Parameters evaluated included patient demographics (age and sex), the clinical presentation of the discharge (gross appearance and laterality), and cytological analysis. Results: Seventy-three (73) patients presented with nipple discharge as their primary complaint. all were females aged between 16-76years with a mean age of 40.6years. the majority were aged between 20-39years. Discharges were unilateral in 67cases (91.78%) [right: 32, left: 35] and bilateral in 6cases (8.22%). Grossly appearing; 27(36.99%) were bloody, 10(13.69%) serous, 13(17.81%) milky, 17(23.29%) mucoid, and 6(8.22%) purulent. Benign cases were the most detected 40/73(54.79%), followed by inflammatory 14(19.18%), then 2(2.74%) suspicious and 1(1.37%) malignant case, and 16(21.92%) non-diagnostic cases. Ductal papilloma 20/73(27.39%) was the most detected benign condition among both the bloody and non-bloody discharges.

Conclusion: This study aimed to identify the different abnormalities in nipple discharges evaluated by nipple discharge cytology. Based on the analysis, it can be concluded that benign conditions are the commonest cases encountered and the main cause of abnormal nipple discharge compared to malignant conditions. the bloody discharge was more associated with benign diseases, therefore, it should not be of serious concern for malignancy. Nipple discharge cytology is a useful method in the diagnosis of malignant and suspicious cases because of its specificity especially in patients presenting exclusively with discharge and it directs patient management in most benign cases.