Nipple overflow (nippledischarge) is a common symptom of breast disease. It can be divided into physiological overflow and pathological overflow. Physiological overflow refers to lactation during pregnancy and lactation, bilateral nipple overflow caused by oral contraceptives or sedatives, and unilateral or bilateral small amount of overflow in postmenopausal women. Pathological overflow refers to natural overflow from one or more ducts on one or both sides that is not related to pregnancy and lactation under non-physiological circumstances, intermittent and persistent from months to years.
I. The causes of nipple overflow are divided into four major categories: physiological, endocrine diseases, breast diseases, drug-induced, etc.
1, physiological overflow
It is often a small amount of clear or milky white overflow from bilateral nipples, which usually flows out after squeezing. Physiological overflow does not require examination and treatment.
2.Endocrine disease
It is often a milk-like overflow from multiple ducts of the breast bilaterally. It is mostly seen in pituitary tumor, thyroid disease, glioma, pineal tumor, liver disease, kidney disease, etc. The relevant endocrine hormones, such as estrogen, prolactin, thyroxine, etc., can be measured to understand the systemic endocrine activity; if brain tumors are suspected, cranial CT examination can also be done.
3.Mammary gland disease
It is often unilateral nipple overflow. It is usually seen in intraductal papilloma, breast trauma, acute mastitis, ductal dilatation, cystic hyperplasia, and plasmacytoid mastitis. Ductoscopy or mammography can be done to understand the ductal lesions. If breast disease is suspected, mammography may be done.
Cancerous overflow (also belongs to breast disease, listed separately) About 5-10% of breast cancers are accompanied by unilateral nipple overflow, which is mostly bloody or plasma blood or watery, and most of them are accompanied by breast lumps. Unilateral nipple discharge with painless small breast lumps is most often seen in early stage intraductal carcinoma. Bilateral nipple discharge breast cancer is rare. In addition, it is worth mentioning that male unilateral breast nipple overflow, whether it is bloody or plasma, should be considered as breast cancer.
4.Medicated overflow
It is often bilateral nipple overflow. It is usually seen after the application of anti-TB drugs, contraceptives, sleeping pills and estrogen. If you suspect drug overflow, you can stop using the relevant drugs and observe whether the nipple overflow will stop.
Second, nipple overflow mainly refers to pathological overflow. According to the visual observation of nipple overflow can be divided into the following 7 types.
1, milk-like fluid: the color of the overflow resembles de-fatted milk. It is common in amenorrhea-overflow syndrome (breast overflow), anterior pituitary hyperfunction syndrome, or after taking oral contraceptives due to the pituitary gland being inhibited from releasing too much lactogen, and some patients with mastocytosis can also appear at this time, often for both sides of the multi-tubular overflow, automatic outflow.
2, pimple-like overflow: mostly caused by ductal dilatation of the breast, the patient mostly has congenital nipple depression, the nipple has a fatty pimple-like with odor discharge overflow. This type of overflow is viscous and mixed with many colors and spontaneously overflows. Usually also bilateral polyductal patients are often accompanied by burning, swelling, itching, also seen in menopausal or young and middle-aged women with hypogonadism.
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3, watery fluid: overflow thin as watery mostly caused by diseases such as intraductal papilloma, cystic hyperplasia of the breast and breast cancer Recently, it is believed that about 50% of watery overflow may be cancer
4, purulent fluid: overflow resembling pus, commonly seen in postpartum acute mastitis breast abscesses.
5.Purulent fluid: light yellow in most cases caused by intraductal papilloma in the lower nipple, also seen in cystic hyperplasia of the breast, ductal dilatation of the breast and breast cancer.
6, bloody fluid or plasma bloody fluid: bloody fluid is red, plasma bloody is pink. Bloody fluid is more common in intraductal papilloma. If a patient over 50 years old has unilateral papillary bloody fluid, it often suggests that it may be intraductal papillary carcinoma and should be given high priority. Plasma blood can be caused by both intraductal papilloma and cystic hyperplasia of the breast and intraductal papillary carcinoma.
7. Light green discharge: the discharge is a lighter and lighter green liquid, which is less common. It is commonly seen in cystic hyperplasia of the breast.
Diagnosis of the cause of nipple overflow: In addition to detailed medical history, comprehensive physical examination and observation of the nature of the overflow, the following diagnostic methods are commonly used
1, exfoliative cytological examination: those who have nipple overflow can do exfoliative cytological examination, especially bloody overflow or single duct overflow exfoliative cytological examination is helpful for the diagnosis of the cause. This method is simple, convenient and easily accepted by patients.
2.Ultrasound imaging examination: non-invasive and can be used repeatedly. Ultrasonography is valuable for those with dense breast tissue, but it is mainly used to identify whether the mass is cystic or substantial.
Mammography: Mammography can detect ductal carcinoma in situ, which is mainly manifested by thickening of ductal shadow and microcalcifications; selective mammography has diagnostic value for ductal dilatation or cystic hyperplasia of breast and intraductal papilloma of breast.
4, histological diagnosis: fine needle aspiration cytological examination is a simple and easy method, but the diagnostic accuracy of benign diseases of nipple overflow is low. Biopsy is the most reliable method for diagnosing the cause of papillary overflow, especially for microscopic lesions, and is the last means of detection when imaging and cytological diagnosis is difficult or suspicious. Biopsy can be performed under imaging localization, endoscopic localization of breast ducts or local injection of dye into the overflowing ducts to remove the diseased ducts and glands for rapid pathological examination.
5.Fiber endoscopic technique: endoscopic examination of breast ducts is the main examination method for breast duct overflow, which can directly observe the epithelium of breast ducts and the duct lumen and decide whether surgical treatment is needed, and can save patients without lesions from surgery. The lesions seen in the ducts can be directly located, retrieved, and biopsied, thus reducing surgical damage.
In conclusion, nipple discharge is an important breast symptom, of which 10-15% may be breast cancer. Symptoms should be seen in hospital in time. Most of the nipple overflow is caused by benign lesions, and only a few of them are caused by breast cancer. Therefore, it is not necessary to be very nervous when you find nipple overflow, but you must not take it lightly. There are many kinds of diseases related to nipple overflow, and the clinical manifestations of various diseases are complicated, different diseases have common clinical symptoms and are not specific, and various auxiliary examinations have their own limitations. Therefore, it is difficult to diagnose and differential diagnosis of nipple overflow diseases. When patients have nipple overflow, they should try to go to the hospital for specialist examination to make a clear diagnosis so as not to miss the best treatment time.