Nipple Discharge Cytology

Nipple Discharge Cytology: Diagnostic Insights into Breast Lesions

Nipple Discharge Cytology

Synonyms: Breast Discharge Cytology

Test Usually Includes

Microscopic examination of stained smear slides prepared from nipple discharge to detect inflammatory or neoplastic breast lesions.

Abstract

The cytological evaluation of nipple discharge provides important diagnostic information, particularly in detecting inflammatory processes or malignancies of the breast.

Specimen

Type: Nipple discharge

Collection Procedure

1. Clean the nipple and areola using warm saline.
2. Using the thumb and forefinger, gently compress the subareolar region and nipple in a pumping motion.
3. Once pea-sized droplets appear, gently press a clean glass slide (with a labeling end) against the nipple and quickly smear.
4. Fix the slide immediately in 95% ethanol.
5. Prepare 4–6 smears depending on sample volume.
6. If self-expression is easier for the patient, allow them to collect the fluid.
7. If eczematous lesions are present, separately scrape the areola to rule out Paget’s disease using a spatula or tongue depressor.

Sample Rejection Criteria

• Hypocellular smears
• Drying artifacts (smears dried before fixation)
• Unlabeled slides
• Insufficient fixative

Turnaround Time

24 hours

Special Instructions

• Clearly indicate the presence of nipple discharge on the request form.
• Provide relevant clinical history, especially noting:
  • Subareolar masses
  • Other dominant breast masses
  • Fibrocystic disease

Clinical Use

Helps in the diagnosis of both inflammatory conditions and neoplastic lesions of the breast, particularly when correlated with imaging or clinical findings.

Limitations

• Smears that dry before fixation often yield poor cytologic detail.
• Hypocellular smears can limit diagnostic utility.

Additional Information

If the sample is sparse and dries in air, submit the air-dried smear for Diff-Quik™ or Giemsa staining for improved cytological detail.

References

• Jacobs, Demott, Finley, Horvat, Kasten JR, & Tilzer. “Laboratory Test Handbook.” Lexi-Comp Inc, 1994.
• Fung A, Rayter Z, Fisher C, et al. “Preoperative Cytology and Mammography in Patients With Single-Duct Nipple Discharge Treated by Surgery.” Br J Surg, 1990; 77(11):1211–2.
• Johnson TL, Kini SR. “Cytologic and Clinicopathologic Features of Abnormal Nipple Secretions: 225 Cases.” Diagn Cytopathol, 1991; 7(1):17–22.
• Takada T, Matsui A, Sato Y, et al. “Nipple Discharge Cytology in Mass Screening for Breast Cancer.” Acta Cytol, 1990; 31:161–4.
• Uei Y, Watanabe Y, Hirota T, et al. “Cytologic Diagnosis of Breast Carcinoma With Nipple Discharge: Special Significance of the Spherical Cell Cluster.” Acta Cytol, 1980; 24:522–8.