Is an open tissue biopsy useful for milk discharge?
July 25, 2014 | 20,00 EUR | answered by Dr. med. Ralf Berg
Good day,
I am about to undergo surgery, but I am not sure if I should go through with it. For months now, I have been experiencing occasional discharge from my right breast. My gynecologist sent me to the hospital for further evaluation, possibly because many of my relatives have died from breast cancer.
After a physical examination, ultrasound, and mammography, no abnormalities were found. Now, a "Open Tissue Biopsy" (sample collection according to Urban) is scheduled to extract tissue from the milk ducts to investigate if there is undetected cancer present. However, I am afraid of complications, especially because I have heard that scarring can occur, making future mammograms difficult, which would be particularly problematic given my family background.
Therefore, I would like to know if there are other methods to extract the necessary tissue. If that is not possible, the question arises of how important the surgery is. Two doctors have already mentioned that changes in the milk ducts are usually benign. Does that mean it may not be urgent to investigate further? Or could they potentially become malignant in the future, requiring regular monitoring if any abnormalities are found (similar to other nodules)?
Thank you for your assistance!
Good evening,
I am happy to answer your questions.
ad 1. With an open biopsy, scarring will inevitably occur. However, the scars are not so large that they would make it difficult to interpret the mammography to the point where it cannot be performed.
ad 2. Of course, there are also non-invasive procedures for tissue sampling (core biopsy, fine needle aspiration, etc.). I believe the reason these procedures are not being used in your case is simply because it is unknown where to place these sample biopsies, as all previous examinations have not uncovered any suspicious areas.
Have you had the pre-operative consultation and consent with the surgeon/gynecologist? Please ask the following: In a case like yours where it is known that a milk duct is active, but there is no idea which milk duct it could be, colored fluid is often injected into the breast ducts and by opening the skin, one can intraoperatively observe where the fluid cannot flow freely under anesthesia. This can help trace the gland that secretes milk. If this is the intention, there are no alternative procedures. (The dye is not visible through the skin).
ad 3. The question of the right time is difficult to answer. On one hand, the very high family risk speaks for clarifying the findings as soon as possible. On the other hand, the high prevalence (expected probability) that a lactating breast usually represents a benign gland malfunction argues against such an approach. And if you have so many cases of breast cancer in the family, you should always have regular check-ups anyway. It is also unfortunately true: every cell in a breast gland can degenerate, even at an older age. And: the earlier a cancer is removed, the better the chances of survival.
My advice: weigh the above arguments for yourself and discuss them again with your gynecologist, but also with the surgeon. Consider whether you can live with the uncertainty, or if you would feel better after the operation knowing that no pathological findings were found.
With kind regards, Dr. R. C. Berg
