Norm of Cytologic Study of Nipple Discharge
Absence of tumor cells or infection.
Usage of Cytologic Study of Nipple Discharge
Diagnosis of inflammatory disease, intraductal papilloma, mammary dysplasia with ectasia of the ducts, metastasis or suspected malignancy of the breast, and papillomatosis.
Description of Cytologic Study of Nipple Discharge
Nipple discharge is considered abnormal except in lactating or pregnant women, though some discharge is caused by medication. Several nipple-discharge smears are fixed on glass slides and microscopically studied for the presence of abnormal cells indicating neoplasm or infection, and, rarely, tuberculosis of the breast. Abnormal cytology indicates increased relative risk for breast cancer.
Professional Considerations of Cytologic Study of Nipple Discharge
Consent form NOT required.
- Explain the procedure. The client who assists should hold the fixative bottle under the breast so that the slide can be immediately placed in the fixative.
- Obtain warmed sterile saline, 6–12 clean glass slides, 6–12 clean glass bottles of 95% ethyl alcohol (ethanol), labels, and cotton or gauze.
- The client should disrobe above the waist.
- Position the client so that it is convenient to obtain the specimen, and drape him or her for privacy.
- Vigorously cleanse the nipple and then soak it in warm saline on a cotton or gauze pad for 10–15 minutes and pat it dry.
- Gently strip the subareolar area with a thumb and forefinger, moving toward the nipple tip. Continue until a pea-sized droplet of fluid is expressed.
- Place the frosted side of a clean glass microscope slide on the nipple and quickly slide it across the nipple tip to obtain a smear of fluid.
- Immediately place the slide into a small jar of 95% ethyl alcohol (ethanol) fixative.
- Label the jar with the number of the smear and whether it was taken from the right or left breast. This is especially important when both breasts are studied.
- Repeat steps 1 through 5 until four to six slides from each breast are obtained, if possible.
- Write a description of the discharge and the client's name, age, clinical symptoms, and which breast is being studied on the laboratory requisition.
- Send the specimens to the laboratory immediately.
- Cleanse the breast and nipple as needed.
Client and Family Teaching
- The procedure takes about 10 minutes.
- Results are normally available within 48 hours.
- About 3% of breast cancers and 10% of benign lesions of the breast are associated with nipple discharge. Negative cytologic results do not rule out a malignancy.
Factors That Affect Results
- Immediate fixation of the smear prevents drying of the sample and distortion of the findings because of contamination.
- Several (rather than one or two) slides improve results because later smears include more abnormal cells if they are present.
- Medications that affect hormonal balance and may cause nipple discharge include chlorpromazines, digitalis, diuretics, oral contraceptives, phenothiazines, and steroids.
- Mammography and biopsy or aspiration are more reliable diagnostic procedures for breast malignancy than cytologic study.