From the Guidelines
The presence of white blood cells (leukocytes) on cytology results is not concerning in cases of nipple discharge, as physiologic nipple discharge is often characterized by a white, green, or yellow color and is typically benign 1.
Key Characteristics of Physiologic Nipple Discharge
- Bilateral
- Originates from multiple ducts
- White, green, or yellow in color
- Milky in appearance
- Occurs only when provoked
Evaluation of Nipple Discharge
In patients with nipple discharge, an evaluation of the characteristics of the discharge is the first step, and suspicion of underlying pathology is raised when the discharge is persistent, spontaneous, unilateral, from a single duct, serous, sanguineous, or serosanguineous 1.
Imaging and Diagnosis
Ultrasound (US) is useful in identifying invasive cancer and assessing the extent of disease, and adds specificity for some lesions when compared with mammography 1.
- US has a reported sensitivity of 56%-80% and specificity of 61%-75% for detection of underlying malignancy in patients with pathologic nipple discharge
- US is useful in identifying and assessing lesions and for biopsy guidance in male and female patients 1
From the Research
Presence of White Blood Cells on Cytology Results
- The presence of white blood cells (leukocytes) on cytology results in cases of nipple discharge is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies do discuss the diagnostic value of nipple discharge cytology in detecting breast cancer and other underlying conditions.
- One study mentions the appearance of inflammatory cells in cytology reports, which was related to ductal ectasia and periductal mastitis 4.
- Another study discusses the presence of red blood cells in cytology reports, which was significantly related to intraductal lesions 5.
- There is no direct evidence to suggest that the presence of white blood cells on cytology results is concerning in cases of nipple discharge.
Diagnostic Value of Nipple Discharge Cytology
- Nipple discharge cytology has been shown to have limited diagnostic value in detecting breast cancer and other underlying conditions 2, 6.
- One study found that nipple discharge cytology had a sensitivity of 16.7% and specificity of 66.1% in detecting malignancy 2.
- Another study found that nipple discharge cytology had a pooled sensitivity of 63% and specificity of 95% in detecting breast cancer 3.
- The presence of bloody or serosanguineous discharge was found to be associated with a higher risk of underlying malignancy 4, 6.
Clinical Evaluation of Nipple Discharge
- Clinical evaluation of nipple discharge, including patient demographics, clinical presentation, and radiological assessment, is important in assessing the risk of underlying breast cancer 6.
- A systematic approach, including Triple Assessment (clinical, radiological, and cytological evaluation), can help accurately define the risk of underlying carcinoma 6.