Papillary secretion. Diagnostic assessment and treatment.
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Papillary secretion is a common symptom in the breast clinic with many different underlying causes like intraductal papilloma, mammary duct ectasia, infected cysts and abscesses, breast cancer/carcinoma in situ (CIS) and rarely pituitary adenoma. The association with cancer/CIS is one of the two main concerns of the patient and must always be ruled out. The second item is that spontaneous and ongoing discharge causes embarrassment due to staining the clothes. Physical examination of the breast, imaging with mammography and ultrasonography should always be done and fine needle biopsy/core biopsy used with wide indications whenever there is any abnormal finding. With the use of modern ultrasonography in the combination with guided biopsy the use for ductography has diminished and might be saved for single duct investigations, especially if papilloma or single duct involvement is suspected. Surgery (when undertaken) due to benign discharge, should aim for radical excision of the underlying cause of the discharge sometimes only a dilated single duct with or without a papilloma or excision of the central ducts as in case of mammary duct ectasia. Discharge should be consistent, spontaneous and disturbing otherwise surgery should not be recommended in the absence of a suspicion of malignancy (negative triple test).