A 46-year-old woman reports spontaneous blood-stained discharge from a single duct of the right nipple. There is no palpable lump, and mammography and ultrasound are normal. Cytology shows no malignant cells. What is the most appropriate management?
- A Total duct excision (Hadfield's procedure)
- B Microdochectomy of the affected duct ✓
- C Annual mammographic surveillance alone
- D Broad-spectrum antibiotics for two weeks
Correct answer: B. Microdochectomy of the affected duct
Explanation
Single-duct spontaneous blood-stained discharge in a woman of this age most commonly arises from a solitary intraduct papilloma, and even with negative imaging and cytology the duct must be excised to exclude occult malignancy. Microdochectomy removes only the implicated duct, identified by probing or methylene blue, preserving lactiferous function. Total duct excision is reserved for multiple duct discharge or diffuse disease, surveillance alone leaves a possible cancer undiagnosed, and antibiotics address infection rather than a structural duct lesion.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.