Evaluation of triple assessment in the management of pathological nipple discharge of the breast at Kenyatta national hospital.

Abstract

Background: Clinicians remain divided on the significance and the management of patients presenting with pathological nipple discharge and on the utility of triple assessment (clinical examination, breast imaging and nipple discharge cytology). Objectives: To determine the sensitivity and specificity of triple assessment in the diagnosis of breast pathology in patients with pathological nipple discharge. Design: Analytic cross-sectional study. Study setting: The Kenyatta National Hospital breast clinic. Methods: Fifty six patients with nipple discharge were prospectively reviewed between April 2012 and March 2013. The sensitivity, specificity, negative predicitive value (NPV), and positive predictive values (PPV) of triple assessment in defining benign and malignant lesions were calculated. Results: The sensitivity and specificity of physical examination was 75% and 79% respectively. That of mammography was 77% (both sensitivity and specificity), ultrasonography 100% and 17% respectively and discharge cytology 14% and 95% respectively. The incidence of carcinoma was 26%. Carcinoma was present in 35% of patients with bloody nipple discharge and in 17% of those with non bloody nipple discharge. The commonest cause of pathological nipple discharge was duct ectasia (53%). Conclusion: there is no singular completely reliable method of examination. A significant risk of carcinoma exists particularly with bloody nipple discharge and surgery should still be offered as part of the management.