Effectiveness of Duct Excision Procedures in Detecting Preneoplastic and Malignant Lesions in Pathological Nipple Discharge: A Retrospective Cohort Study

Background and Aims: Nipple discharge ranges from benign to pathological, indicating inflammation or epithelial proliferation. In 5%-28% of cases, pathological nipple discharge (PND) may indicate breast carcinoma. Our objective was to evaluate the detection rates of malignant and high-risk lesions (HRL) in patients undergoing major duct excision (MDE) and microductectomy for diagnostic purposes due to PND and to assess the need for re-excision in malignancies. Method: Patients diagnosed with PND between October 2015 and December 2023 underwent duct excision procedures after physical, imaging, and histopathological examinations, if necessary. Patients with malignancies detected by histopathological evaluation underwent oncological procedures and were excluded from the study. Results: Among 118 patients, 80 underwent microductectomy and 38 underwent MDE. Intraductal lesions (ILs) were detected in 62% of cases, with higher detection rates in the microductectomy group (69% vs. 47%, p < 0.03). Of these lesions, 23 were classified as HRL (24% in the microductectomy group vs. 11% in the MDE group, p = 0.09). Malignancy was detected in 16 patients (13.6%), with a higher rate in the MDE group (18% vs. 11%, p = 0.3). Five patients required re-excision for clear surgical margins, with no significant difference between the groups (microductectomy: n = 2; MDE: n = 3, p = 0.3). Conclusion: The malignancy detection rate was slightly higher in the MDE group; however, this difference was not statistically significant. Similarly, there was no significant difference in the need for re-excision. Microductectomy, which preserves lactation function, may be preferred for premenopausal individuals or those considering future pregnancies when clinical presentation supports single-duct involvement. The differing distribution of IL and HRL between procedures reflects the pathology associated with their respective clinical indications rather than a difference in diagnostic performance.