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14
Evaluating Nipple Discharge Cytology's Organizational Service and Test Suitability (END COSTS)

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Introduction
Nipple discharge cytology is a recommended investigation for symptomatic discharge current departmental guidelines at the Princess Alexandra Hospital, a district general hospital in Harlow in the UK. We retrospectively evaluated this investigation’s role in the hospital’s breast service.
Methods
We reviewed the records of all 220 patients from January 1st, 2010 to October 15th, 2016 who underwent nipple discharge cytology in breast clinic. Basic demographics were collected along with results from mammogram, ultrasound, palpation, nipple discharge cytology, fine needle aspiration, core biopsy, and surgical tissue biopsy whenever available. Nipple discharge cytology was compared against control values from needle aspiration, core biopsy, or surgical histology for ROC curve analysis.
Results
Nipple discharge cytology was reported as C4 or C5 in 11 cases (5.0%), of whom all were over the age of 50 and were investigated by other modalities. Of those 10 cases, none had their management changed due to cytology results as all proceeded to FNAC or core biopsy.
100% of women under the age of 50 who underwent nipple discharge cytology had negative (C2/C3) results (n=109). The sensitivity of the test was 45.0% and the specificity was 99%. ROC curves for nipple discharge cytology in all age groups suggest the test is anti-diagnostic in our cohort. Our cohort’s results suggest that diagnosis is best achieved by omitting the test in all age groups.
The cost of performing a single nipple discharge cytology is approximately £28.86; by omitting this test entirely, the department would save over £1100 and would align its guidelines with national and international recommendations.
Conclusion
Nipple discharge cytology was of little to no value in diagnosis in our cohort and never changed management. We recommend that it should be removed from our hospital guidelines.

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