What is the significance of nipple discharge with 1+ epithelial cells?

From the Guidelines

Nipple discharge with 1+ epithelial cells is a significant finding that warrants medical evaluation to rule out underlying breast malignancy or high-risk lesions, despite the majority of cases being benign. This finding indicates the presence of some epithelial cells in the discharge, which can occur in various breast conditions, including ductal ectasia, intraductal papilloma, or fibrocystic changes 1. According to the American College of Radiology, the presence of epithelial cells in nipple discharge can be a sign of an underlying breast condition, and further evaluation is necessary to determine the cause 1.

Key Considerations

• The discharge is from a single duct, is spontaneous, or is bloody, which are characteristics of pathologic nipple discharge 1
• The patient's medical history, including prior breast cancer, BRCA mutation, or atypia on core needle biopsy (CNB) 1
• The results of imaging tests, such as mammography, ultrasound, or ductography, which can help identify the cause of the discharge 1

Recommended Evaluation

• Schedule an appointment with a healthcare provider for a complete breast examination
• Additional tests, such as mammography, ultrasound, or ductography, may be recommended to identify the cause of the discharge 1
• Image-guided core biopsy (CNB) may be necessary to obtain a tissue diagnosis and assist in patient management 1
• Major duct excision may be considered if imaging tests are unremarkable and there is a high suspicion of underlying malignancy or high-risk lesion 1

Important Notes

• Avoid nipple stimulation and document any changes in the discharge color, frequency, or associated symptoms while waiting for the appointment
• Most nipple discharge with epithelial cells is due to benign conditions, but it is essential to rule out more serious conditions like ductal carcinoma 1
• The epithelial cells seen in the discharge originate from the lining of the milk ducts, and their presence in small numbers (1+) is often not concerning but requires proper evaluation to ensure appropriate management 1

From the Research

Significance of Nipple Discharge with 1+ Epithelial Cells

• Nipple discharge can be a symptom of various breast conditions, including benign and malignant lesions 2, 3, 4, 5, 6
• The presence of epithelial cells in nipple discharge can indicate an underlying breast condition, such as ductal ectasia, fibrocystic changes, or intraductal pathology 2
• However, the presence of 1+ epithelial cells in nipple discharge is not necessarily indicative of a malignant condition, as most cases of nipple discharge are benign 4, 5
• Studies have shown that the risk of malignancy is higher when the discharge is uniductal, unilateral, spontaneous, persistent, bloody, or serous, as well as when it is accompanied by a breast mass 4, 5

Diagnostic Evaluation

• Imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI) can be used to evaluate nipple discharge 3, 4, 6
• Ultrasound is considered a useful modality for visualizing ductal structures and intraductal lesions that cause nipple discharge 3
• Ductography, although less commonly used, can also be helpful in characterizing intraductal filling defects 2
• The diagnostic application of duct cytology in patients presenting with nipple discharge is limited, and its use is not recommended as a routine diagnostic tool 5

Management Considerations

• A thorough history and physical exam are essential in evaluating patients with nipple discharge 6
• Imaging recommendations should be guided by the presence of risk factors, such as age, bloody discharge, and presence of a breast lump 4, 5
• A step-by-step management approach, including imaging and clinical evaluation, can help differentiate physiologic from pathologic nipple discharge and guide further management 6