Papillomas may be seen with microscopic examination of a nipple discharge, but this test may be inconclusive. If the discharge is bloody or serous, a mammogram is often the first test to be performed. Even when no cancer cells are found in a nipple discharge, it is not possible to rule out breast cancer or other condition such as papilloma. If a patient has a suspicious mass together with nipple discharge, evaluation of the mass should be performed using mammography, adjunctive imaging and biopsy as necessary. If these tests are negative and show no malignancy, nipple smear should be evaluated.
Some papillomas are near the nipple and are large enough to be felt.
In these cases, a needle biopsy can be done to test for malignancy or diagnose papilloma. However, a ductogram that does not show an abnormality does not exclude the fact that a significant lesion may be present. The standard treatment for nipple discharge that has no hormonal involvement is duct excision. Duct excision is usually performed on an outpatient basis with local anesthesia. The procedure is usually done through a small circular incision near the areolar border around the nipple.