Clinicopathological features and oncological outcomes in breast cancer presenting with nipple discharge

Nipple discharge may indicate subareolar or nipple–areola complex (NAC) involvement in nipple discharge-associated breast cancer, which has important implications for surgical planning and prognosis. This study aimed to analyze the clinicopathological features, radiological findings, and oncological outcomes of breast cancer patients presenting with nipple discharge. Patients who presented with nipple discharge and underwent surgery with a histopathological diagnosis of breast cancer between January 2005 and January 2020 at three tertiary referral centers were retrospectively reviewed. Demographic, clinical, radiological, and pathological data were collected. Demographic, clinical, radiological, and pathological data were retrospectively collected. A total of 205 patients were included. Of those, 71.8% presented with bloody discharge. Most patients had early-stage disease (pTis/T1: 78.8%). Overall, pathological NAC involvement was identified in 26.5% of cases, whereas it was estimated as 34.5% in mastectomy cases, and 60% in patients with MRI-suspicious findings and 48.7% in those with a non-luminal pathology. MRI demonstrated the highest diagnostic accuracy (AUC 0.756, p < 0.001) for detecting NAC involvement independent predictors of NAC involvement were non-luminal subtype (OR 3.15, 95% CI, p = 0.004) and retroareolar mass (OR 2.57, 95% CI, p = 0.012). At a median follow-up of 68 months, locoregional and distant recurrence rates were 2.9% and 9.3%, respectively. No significant differences in disease-free or disease-specific survival were observed between patients undergoing breast-conserving surgery and those treated with mastectomy, or between patients with and without NAC involvement. Lymphovascular invasion and nodal positivity were associated with reduced DFS. Breast cancers associated with nipple discharge are most often diagnosed at an early stage. Careful clinical and radiological evaluation of nipple–areola complex (NAC) involvement is essential in these patients due to the high NAC involvement in clinical and imaging suspicious cases and aggressive tumor biology. When NAC involvement is excluded, breast-conserving surgery and nipple-sparing mastectomy can be considered in appropriately selected patients, with comparable oncological outcomes.