A 50-year-old woman presents with spontaneous single-duct nipple discharge that is blood-stained. Smear cytology is negative for malignancy. What is the most appropriate investigation and management?
- A Microdochectomy of the responsible duct ✓
- B Mammography and observation if normal
- C Ductal lavage for cytology
- D Total duct excision (Hadfield procedure)
Correct answer: A. Microdochectomy of the responsible duct
Explanation
Unilateral, single-duct, spontaneous blood-stained nipple discharge in a patient over 40 requires surgical excision to exclude intraductal papilloma or ductal carcinoma in situ (DCIS). Microdochectomy (excision of the single responsible duct) is the definitive investigation and treatment — the most common cause is an intraductal papilloma, found in ~80% of cases. Total duct excision (Hadfield) is performed for multiduct discharge or when the responsible duct cannot be identified. Observation is inappropriate for blood-stained discharge.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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