The accuracy of nipple discharge cytology in detecting breast cancer

Areej Al Nemer; Haitham Kussaibi

doi:10.1515/dx-2020-0026

Article

The accuracy of nipple discharge cytology in detecting breast cancer

Areej Al Nemer and Haitham Kussaibi

Published/Copyright: June 26, 2020

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From the journal Diagnosis Volume 8 Issue 2

Abstract

Objectives

This study aimed to disclose the importance of nipple discharge (ND) and the accuracy of its economic and fast cytological interpretation.

Methods

All ND cytology cases for Saudi patients done between 2004 and 2013 were retrieved from the Pathology e-system. Only cases that have subsequent tissue diagnoses were included in this study (n = 228). Age and bloody nature of the ND were both tested for association with a higher chance of carcinoma. Diagnostic accuracy of ND cytology was calculated twice, including and excluding the “atypical” cases.

Results

Specificity and positive predictive value were 100% for ND cytology in both cases. Sensitivity (34.6%; 52.9%), negative predictive value (93.15 %; 96.1%), false-negative rate (65.4%; 47.1%), accuracy rate (93.4%; 96.2%), when atypical cases were included and excluded; respectively. Only 10.5% of the patients complaining from nipple discharge had breast cancer. For those who had cancer, nipple discharge cytology was positive and showed the cancer cells in only 37.5%, while the rest were false negative. Bloody ND disclosed a significant association with malignancy (p < 0.001), but the association was statistically not significant for old age (p = 0.062).

Conclusions

The prospect of having breast cancer with the presentation of ND is low, and it can be missed by studying the ND cytology alone in a high proportion of cases. Excluding the atypical category did not make a significant improvement in the test’s accuracy.

Keywords: breast; cancer; cytology; diagnosis; nipple discharge

Corresponding author: Areej Al Nemer, MD, Associate Professor and Consultant, Breast Pathologist, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia, E-mail: aanemer@iau.edu.sa

Funding source: Imam Abdulrahman Bin Faisal University

Award Identifier / Grant number: 2014166

Research funding: This work is part of Breast Pathology Research, funded by Imam Abdulrahman Bin Faisal University (Grant number 2014166).
Author contributions: Both authors are responsible for data collection, interpretation and write-up of the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent is not required in this retrospective laboratory-based study in compliance with the World Medical Association Declaration of Helsinki.
Ethical approval: The study was carried out with the approval of the local Ethics Committee (Grant number 2014166), and in compliance with the World Medical Association Declaration of Helsinki regarding ethical conduct of research involving human subjects.

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Received: 2020-02-17

Accepted: 2020-05-04

Published Online: 2020-06-26

Published in Print: 2021-05-26

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Articles in the same Issue

https://doi.org/10.1515/dx-2020-0026

Keywords for this article

breast; cancer; cytology; diagnosis; nipple discharge