A 55 yo female presents with a bloody discharge from her left breast

A 55 yo female presents with a bloody discharge from her left breast. Asides for some mild pain, she denies weight loss, fever, chills or malaise. She has no history of breast cancer and her last mammogram done 3 years ago was normal. On exam there is no palpable mass. The bloody discharge is sent for immunohistochemistry. Then she undergoes the study shown below. To make a firm diagnosis, which technique may not be helpful?

a. Open tissue biopsy

b. Vacuum assisted biopsy

c. Fine needle biopsy

d. Core needle biopsy

  1. Bloody nipple discharge from an intraductal papilloma is not rare. Women of all ages can develop intraductal papillomas. Breast tumor risk factors include contraceptive use, hormone replacement therapy, lifetime estrogen exposure, and family history. Near the end of the ductogram one can see an outline of a circular mass.

  2. Patients with symptoms often present with spontaneous bloody or clear nipple discharge. An intraductal papilloma may be occasionally palpable. However, most patients with an intraductal papilloma are asymptomatic. Small intraductal papillomas often will show no signs or symptoms.

  3. Tissue sampling in addition to imaging is necessary for the diagnosis of intraductal papilloma. Radiologic findings and pathologic tissue findings need to be concordant for accurate diagnosis.

  4. There are different types of biopsy methods which include core needle, vacuum assisted, and open tissue biopsy.Fine needle aspiration uses a thinner needle creating the chance for insufficient tissue sampling.