Role of nipple discharge cytology in predicting NAC involvement in carcinoma breast

  • Sumanashree Mallappa Department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
  • Nimisha Sharma department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
  • Uma Sharma department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
  • Arti Khatri department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
  • Vimal Bhandari department of surgery Vardhman Mahavir Medical College and Safdarjung Hospital
Keywords: Nipple discharge cytology, Nipple areolar complex, Breast carcinoma, Conservative mastectomy

Abstract

IntroductionCancer of the breast in women is a major health burden worldwide. It is the most common cause of cancer among women in both high-resource and low-resource settings, and is responsible for over one million of the estimated 10 million neoplasms diagnosed worldwide each year in both sexes. Limited number of studies have addressed the optimal surgical management of patients with breast carcinoma associated with benign or pathologic nipple dischargeMaterial and methods-Thirteen breast carcinoma cases with nipple discharge were studied. Nipple discharge cytology was studied using giemsa method. Later all the mastectomy specimens were inked and sectioned from medial to lateral into no greater than 1 cm thick tissue sections and grossly examined. Extensive sampling of nipple areola was followed taking 12 sections from each nipple areolar complex.Thirteen breast carcinoma cases without nipple discharge were chosen as control and also grossed and examined for nipple areolar involvement .Results-In our study, there were 13 cases with nipple discharge. Out of which, 10 cases were having benign cytologic findings and 3 cases showed malignant cytologic findingsSpss statistical software was used which showed no association between presence of nipple discharge and nipple areolar involvement also it showed no association between malignant nipple discharge cytologic findings and nipple areolar involvement.Conclusions-Nipple discharge itself has no association with nipple areolar involvement and should not deter a clinician from nipple sparing mastectomy if other factors are conducive. Careful patient selection can be done in cases with malignant nipple discharge cytologic findings, if negative margins could be achieved and appropriate adjuvant therapy given.Further studies are needed to study the role of nipple discharge cytology in conservative mastectomy procedures.DOI: 10.21276/AWCH.1543 

Author Biographies

Sumanashree Mallappa, Department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
Pathology senior resident
Nimisha Sharma, department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
Senior residentdepartment of pathologyVardhman Mahavir Medical College and Safdarjung Hospital
Uma Sharma, department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
consultant and professordepartment of pathologyVardhman Mahavir Medical College and Safdarjung Hospital
Arti Khatri, department of pathology Vardhman Mahavir Medical College and Safdarjung Hospital
Senior residentdepartment of pathologyVardhman Mahavir Medical College and Safdarjung Hospital
Vimal Bhandari, department of surgery Vardhman Mahavir Medical College and Safdarjung Hospital
professor and consultantdepartment of SurgeryVardhman Mahavir Medical College and Safdarjung Hospital

References

1. Kumar V,Abbas AK ,Fausto N, Aster JC. The Breast. In: Robbins and Cotran Pathologic Basis of Disease,Eighth ed.Pennsylvania:WB Saunders; 2010: 1065-1096.
2. Krishnamurthy S , Sneige N ,Thompson PA ,Marcy SM , Singletary SE et al. Nipple Aspirate
3. Fluid Cytology in Breast Carcinoma. Cancer cytopathology 2003;99:97-104
4. Falkenberry SS. Nipple Discharge: Breast Disease Diagnosis and Contemporary management 2002;29:20-29
5. Cabioglu N, Krishnamurthy S, Kuerer HM, Hunt KK, Singletary SE . Feasibility of breast conserving surgery for patients with breast carcinoma associated with nipple discharge. Cancer 2004 ;101(3):508-17.
6. T. Richards, A. Hunt, S. Courtney, H. Umeh, “Nipple discharge: a sign of breast cancer?” Ann R Coll Surg Eng 2007 ;89( 2): 124–126.
7. Verma GR, Kumar A, Joshi K. Nipple involvement in peripheral breast carcinoma :a
prospective study. Indian Journal of Cancer 1997;34:1-5.
8. Millard DR, Devine J, and Warren WD. A Plea for Saving the Uninvolved Nipple. Am J Surg 1977;122:763.
9. Parry RG, Cochran TA, Wolfort FG. When is the Nipple involved in Carcinoma of the Breast? Plast Reconstr Surg 1977,59(4):535.
10. Smith J, Payne WS, Carney JA. Involvement of Nipple and Areola in Carcinoma of the Breast. Surg Gynecol Obstet 1976;143:546-8.
11. Khan K, Chakraborti S, Mondal S. Morphological predictors of nipple involvement in malignant breast tumours. Indian Journal of Pathology and Microbiology 2010;53(2):232-237.
12. Menon RS, Geel ANV . Cancer of breast with nipple involvement. Br journal of cancer
1989;59:81-4
13. Vyas JJ, Chinoy RF, Vaidya JS. Prediction of Nipple Areola Involvement in Breast Cancer. Eur J Surg Oncol 1998;24: 15-16.
14. Laronga C, Kemp B, Johnston D, Robb GL, Singletary SE et al: The incidence of occult nipple areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999;6:609-613.
15. Andersen JA, Gram JB, Pallesen RM (1981) Involvement of the nipple and areola in breast cancer. Value of clinical findings. Scand J Plast Reconstr Surg 15(1):39–42.
16. Morimoto T, Komaki K, Inui K, Umemoto A, Yamamoto H et al: Involvement of nipple and areola in early breast cancer. Cancer 1985; 55: 2459-63.
17. Luttges J, Kalbfleisch H, Prinz P: Nipple involvement and multicentricity in breast cancer: A study on whole organ sections. J Cancer Res Clin Oncol 1987;113:481-7.
18. Lagios MD, Gates EA, Westdahl PR, Richards V, Alpert BS et al: A guide to the frequency of nipple involvement in breast cancer: A study of 149 consecutive mastectomies using a serial subgross and correlated radiographic technique. Am J Surg 1979;138:135-142.
19. Quinn RH, Barlow JF. Involvement of the nipple and areola by carcinoma of the breast. Arch Surg 1981;116:1139-40.
20. Kissin MW, Kark AE. Nipple preservation during mastectomy. Br J Surg 1987;74:58 61.
21. Vlajcic Z, Zic R, Stanec S, Lambasa S, Petrovecki M,Stanec Z. Nipple–areola complex
preservation: predictive factors of neoplastic nipple–areola complex invasion. Ann Plast Surg 2005; 55: 240–244.
22. Wertheim U, Ozzello L: Neoplastic involvement of nipple and skin flap in carcinoma of the breast. Am J Surg Pathol 1980 ; 4:543-54
23. N. Cabioglu, K. K. Hunt, S. E. Singletary , Stephens TW, Marcy S et al. “Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge,” Journal of the American College of Surgeons 2003; 196(3): 354–364
24. Pang BS, Bu DS, Kim YH, Paik NS, Moon NM. The Clinicopathologic Characteristics of Breast Carcinoma associated with Nipple Discharge. J Breast Cancer 2007;10(1):90-94.
Published
2017-07-11
Section
Original Articles