| Nipple discharge means that the non-lactating female have effluence of liquid from the nipple,one of the three major clinical symptoms of breast diseases,and it's incidence is after the breast mass and pain.According to a comprehensive literature,the incidence was from 3% to 8%.The causes of nipple discharge is very complicated,and it's a complex diagnostic challenge for the clinician.Nipple discharge can be divided into two types:physiological and pathological. Physiological nipple discharge is main related to female hormone levels increased of menstrual cycle,fertility,breast-feeding or medication,etc.Pathological nipple discharge can be devided into two types:systemic causes and breast itself lesion. Systemic causes include:endocrine disorders,pituitary tumor,thyroid disease or chronic liver disease,etc.Most nipple discharge is secretory,and surgical treatment is not required.Breast itself lesion:nipple discharge caused by ductal epithelial hyperplasia, loss, inflammation, hemorrhage, necrosis, tumor ,etc.For example:A variety of diseases (such as intraductal papillomas,mammary duct ectasia, breast cancer, pituitary adenomas, breast abscesses or infections, etc.) can manifest as nipple discharge.The surgical treatment is not required.Pathological nipple discharge a true, direct drainage from the mammary duct or ducts, which appears on the surface of the nipple. Nipple discharge is considered as one of the bases of the main diagnosis for some intraductal lesions,especially for the breast cancer.In addition the cause can be helpful for the decision for the clinical treatment options and the prognosis of the patients.So defining the nature of the desease is very important.Breast cancer is one of female's most common malignancy,it has become the first one of female's malignant tumors in some major cities. Physical and mental health of women was seriously affacted.how to prevent,as well as early detection,early diagnosis and early treatment of breast cancer has become the focus of study.Today high risk factors for the breast cancer of patients with nipple discharge include:>50 years old,bloody discharge,accompanied by breast mass.We retrospectively analyzed the nipple discharge cases to verify whether the three factors above will be high risk factors of breast cancer and discuss the relationships between calcification,the course of disease and benign or malignant breast discharge.to provide a scientific basis to more effective treatment of nipple discharge.Objective:Retrospectively analyze the nipple discharge cases.To study the relationships between the clinical factors(featue of nipple discharge,age of patients, whether accompanied by breast mass,breast calcification and the course of disease) and benign or malignant breast discharge.Methods:The clinical data of 207 cases with nipple discharge treated in the First hospital of Jilin university from January 2000 to December 2009 was studied retrospectively.assorted arrange the data.The relationship between the clinical factors(character of nipple discharge,age of patients, accompanied by breast mass ,calcification and the course of disease) and benign or malignant breast discharge was analyzed by using univariate and multivariates analysis.Using SPSS13.0 statistical software to statistically analyze the data.Using Fisher's exact test for calcification,χ2 test for age of patients,the feature of nipple discharge and whether accompanied by breast mass,Kruskal Wall test for the course of disease to carry on the univariate analysis,if P<0.05,there will have statistical significance.At last,using Univariate Logistic Regression to analyze the four factor to take up which factor can affact benign or malignant breast discharge,the results include:age of patients, whether accompanied by breast mass and breast calcification.Analyze the three factors again by using multiple logistic regression.Find out whether there is statistical significance.Results:207 female non-pregnancy and non-lactating patients with nipple discharge.They were form 19 to 76 years old,average age is 44.6 years.their course of nipple discharge were from one day to ten years.There are 73 cases who is accompanied by breast mass.The main feature of nipple discharge is bloody.Include:133 cases of bloody, 56 cases of serous,10 cases of watery,7 cases of milky,1 case of pus-like.In 91cases of x-ray,there were 24cases accompanied by breast calcification.According to BI-RADS classification, 19cases of≥4th, 5cases of≤3rd.207cases all were given operation.Paraffin pathological results after the operation:in group of bloody:54 cases of intraductal papillomas (40.60%),21 cases of mammary duct ectasia(15.79%),20 cases of cystic hyperplasia(15.04%), 37 cases of breast cancer(27.82%),1 cases of fibroadenoma(0.75%).In group of serous :24 cases of intraductal papillomas(42.86%), 14 cases of mammary duct ectasia(25.00%),5 cases of cystic hyperplasia(8.93%),13 cases of breast cancer(23.21%).In group of watery:4 cases of intraductal papillomas(40.00%), 1 cases of mammary duct ectasia,1 cases of cystic hyperplasia and 1 cases of fibroadenoma(total 30.00%),3 cases of breast cancer(30.00%).In group of milky:1 cases of mammary duct ectasia,3 cases of cystic hyperplasia,1 cases of intraductal papillomas.In group of pus-like:1 case of paget's desease.In 153 cases of benign breast discharge:123 cases≤50,years old,30 cases >50 years old.In 54 cases of breast cancer: 28 cases≤50,years old,26 cases>50 years old.73 cases of nipple discharge accompanied by breast mass,43 cases of breast cancer,30 cases of benign breast discharge.134c ases of only nipple discharge,11 cases of breast cancer,123 cases of benign breast discharge.This artical analyzed the relationships between the clinical factors(age of patients, feature of nipple discharge,accompanied by breast mass,breast calcification and the course of disease) and benign or malignant breast discharge by using univariate and multiple factors analysis.(1)Univariate analysis: The patients over 50 years old with nipple discharge had much higher risks of suffering from breast cancer than the patient under or equal to 50 years old(P<0.05).The patients with nipple discharge accompanied by breast mass had much higher chance of suffering from breast cancer than the patients with only nipple discharge (P<0.05). The patients with nipple discharge accompanied by breast calcification had much higher chance of suffering from breast cancer than the patients with only nipple discharge(P<0.05).The feature of nipple discharge and the course of disease have nothing to do with diagnosing benign or malignant nipple discharge(P>0.05) .(2)Multivariates analysis:Through their respective OR values, we know:①The patients over 50 years old with nipple discharge had 7.300 times of suffering from breast cancer than the patient under or equal to 50 years old.②The patients with nipple discharge accompanied by breast mass had 10.063 times of suffering from breast cancer than the patients with only nipple discharge.the high risk factors of the breast cancer were over 50 years old,nipple discharge accompanied by breast mass(P<0.05). breast calcification:OR value is 8.456The risk factors of the breast cancer from higher to lower:classification of≥4th grade,classification of≤3rd grade and without calcification.Conclusion:(1)The patients over 50 years old with nipple discharge had much higher risks of suffering from breast cancer than the patient under or equal to 50 years old.(2)The patients with nipple discharge accompanied by breast mass had much higher chance of suffering from breast cancer than the patients with only nipple discharge(3)The patients with nipple discharge accompanied by breast calcification had much higher chance of suffering from breast cancer than the patients with only nipple discharge.(4)Age of patients , whether or not accompanied by breast mass and breast calcification have important clinical significances in diagnosing benign or malignant nipple discharge.
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