Nipple Discharge

PURPOSE:

To describe collection and transportation methods of nipple discharge for cytologic evaluation.

Note: For breast cysts, see procedure for Fine Needle Aspiration

PROCEDURE:

Step 1

Cytology is useful in detecting presence of cancer cells and determining the nature of breast discharge. Any breast secretion, besides normal milk, is abnormal.

Step 2

Fill in pertinent patient information and date of collection. Print the requested information on the form. Complete the form for specimen type, date, clinical history and diagnosis.

Step 3

The preferred method of collection of any nipple discharge or other breast secretion (not to include palpable masses) is to first cleanse the area and then by applying pressure around the area. Collect as much of the fluid as possible in a Cytolyt container. Cytolyt is a fixative that creates for easy transportation of the sample and for preserved specimen integrity. Each area of ulceration and or drainage should have a separate bottle. Each bottle should be completely labeled and noted which bottle goes with which area. i.e. left nipple, right nipple, left breast at 1 o’clock etc.

Step 4

If cytolyt bottles are not available, the specimen may be collected onto frosted-edge slides. Obtain 2 frosted-edge slides, an alcohol prep pad, Cytology spray fixative, and cardboard slide holders. These are available from CAP-LAB. If the collecting office does not have any form of cytology fixative, DO NOT perform the procedure until proper fixative is obtained. The lack of fixative can distort the cellularity and cause an accurate diagnosis to become difficult.

Label the 2 slides with the patient’s full name and specimen source. Number the slides 1 and 2.

Step 5

Wipe nipple surface with the alcohol prep pad to prevent contamination of the nipple.

Step 6

Express the secretion by gently compressing the areola area between the thumb and index finger. Begin vertically, and then rotate in a clockwise direction to include the entire area. Note on the cytology form when a specific directional pressure produces a significant secretion.

Step 7

The secretion on the nipple is smeared by placing the slide at the nipple and performing a lengthwise motion.

Step 8

IMMEDIATELY spray the slide with Cytology fixative to avoid air-drying. Two sprays per slide are adequate. Hold the spray bottle 6-8 inches from the slide.

Step 9

Express new secretion for each of the slides. Repeat steps 5-8 for each slide.

Step 10

As many slides as possible should be attempted due to findings that diagnostic cells most often appear on latter slides. The first few slides often contain degenerated cells.

Step 11

When the secretion is very scant, the slide can be touched lightly against the nipple, making an imprint smear.

Step 12

When the nipple erosion or ulceration is present, physiological saline can be added to erosion fluid, gently mix with the lesion to exfoliate cells, and smear on sterile slides as above.

Step 13

Allow slides to dry completely before putting into the cardboard slide holders.

Step 14

Seal the cardboard holder shut with tape; fold and wrap the Cytology form around the holders. Secure with a rubber band, place in plastic bag.

Step 15

Send specimens to CAP-LAB. 517-372-5520

REFERENCES:

Masukawa, Teru, (1975) Breast Cytology Compendium on Diagnostic Cytology, 3rd Ed., ASC.

Frost, John H., (1975) Obtaining Cell samples From the Breast – Manual of Cytotechnology, 4th Ed., ASCP.