Breast carcinoma presenting with nipple discharge is not uncommon. However, few studies have addressed the clinicopathological characteristics and optimal surgical management of breast carcinoma with nipple discharge. The aims of this study were to determine the clinicopathologic characteristics of breast carcinoma that presents with nipple discharge and the feasibility of breast conservation for these patients.

We retrospectively reviewed the medical records of the patients with breast carcinoma who presented with nipple discharge and who also underwent curative surgery at Korea Cancer Center Hospital between January 1999 and December 2003.

During the study periods, 40 of 1,442 (2.7%) breast cancer patients presented with nipple discharge, and among them, 28 (70%) patients were accompanied by a palpable breast mass. Their median age was 44 yr. Thirty-seven (93%) patients were treated with mastectomy and only 3 (7%) patients were treated with breast conservation. Eleven patients had ductal carcinoma in situ, 17 had stage I disease, 8 had stage II disease and 4 had stage III disease. On the pathologic evaluation, multifocality or multicentricity were found in 7 of 37 (19%) mastectomy specimens, and occult nipple-areola complex (NAC) involvement was found in 3 (8%) cases. In 23 of 37 (62%) mastectomy specimens, we didn't find any evidence of extensive disease (stage III, multicentricity or multifocality or occult NAC involvement) that may preclude breast conservation. Locoregional recurrence was not detected in any of these cases, and 37 of 40 patients are free of disease with a median follow-up of 55 months.

In this retrospective study, we found that 23 of 37 (62%) women with breast carcinoma associated with nipple discharge and who also underwent mastectomy had no evidence of extensive disease. Thus, we suggest that breast conservation can be done for these patients with performing careful patient selection and appropriate adjuvant therapy.