A 25 year old lady presents with spontaneous nipple discharge of 3-months duration. On examination the discharge is bloody and from a single duct. The following statements about management of this patient are true except -
Ans. is 'b' i.e., radical duct excision is the operation of choice CSDT writes - "Unilateral, spontaneous, serous or serosanguineous discharge from a single duct is usually caused by an intraductal papilloma or rarely, by an intraductal cancer." Mostly the underlying cause is a duct papilloma or duct ectasia, but since the chances of malignancy are high, it must be investigated fuher. the risk of malignancy increases if an underlying mass is present. Investigation used are Mammography - can show any underlying suspicious lesion Cytological examination - this may identify malignant cells, but a negative finding does not rule out cancer. Galoctography/Ductography The primary indication for ductography is nipple discharge, paicularly when bloody. Ductography though helpful in reaching a diagnosis is not essential, since excision of bloody duct system is indicated regardless of finding. In this study, a contrast medium is injected into the discharging duct and a mammogram taken. The injected may show a intraductal papilloma as a filling defect surrounded by contrast. Cancers may appear as irregular masses or as multiple intraluminal filling defects, or abrupt obstruction. Duct ectasia or fibrocystic disease may appear as dilated cystic structures Ultrasound - may show presence of an underlying mass or duct ectasia. The final diagnosis is made by excising the involved duct (Microdochotomy) and any underlying mass if present and subjecting them for a histopathological diagnosis. Radical duct excision (meaning removal of all lactiferous ducts) is not done.