A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge

Yamamoto, Daigo; Shoji, Tetsuji; Kuroda, Hiroshi; Nakagawa, Hiroyuki; Haijima, Hiromasa; Gondo, Hideki; Tanaka, Kanji

doi:10.1023/a:1012990809466

Cited by 70 publications

(53 citation statements)

References 8 publications

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“…Yamamoto et al [30] reported a specificity of 94.3%, a sensitivity of 50%, and an efficiency of 89.7%. Matsunaga et al [31] compared nipple swab, biopsy, and cytologic ductal lavage.…”

Section: Discussionmentioning

confidence: 99%

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Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

et al. 2014

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SummaryBackground: According to the literature, ductoscopy is gaining increasing importance in the diagnosis of intraductal anomalies in cases of pathologic nipple discharge. In a multicenter study, the impact of this method was assessed in comparison with that of standard diagnostics. Patients and Methods: Between 09/2006 and 05/2009, a total of 214 patients from 7 German breast centers were included. All patients underwent elective ductoscopy and subsequent ductal excision because of pathologic nipple discharge. Ductoscopy was compared with the following standard diagnostics: breast sonography, mammography, magnetic resonance imaging (MRI), galactography, cytologic nipple swab, and ductal lavage cytology. The histological and imaging results were compared and contrasted to the results obtained from the nipple swab and cytologic assessment. Results: Sonography had the highest (82.9%) sensitivity, followed by MRI (82.5%), galactography (81.3%), ductoscopy (71.2%), lavage cytology (57.8%), mammography (57.1%), and nipple swab (22.8%). Nipple swabs had the highest (85.5%) specificity, followed by lavage cytology (85.2%), ductoscopy (49.4%), galactography (44.4%), mammography (33.3%), sonography (17.9%), and MRI (11.8%). Conclusion: Currently, ductoscopy provides a direct intraoperative visualization of intraductal lesions. Sensitivity and specificity are similar to those of standard diagnostics. The technique supports selective duct excision, in contrast to the unselective technique according to Urban. Therefore, ductoscopy extends the interventional/diagnostic armamentarium.

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“…Yamamoto et al [30] reported a specificity of 94.3%, a sensitivity of 50%, and an efficiency of 89.7%. Matsunaga et al [31] compared nipple swab, biopsy, and cytologic ductal lavage.…”

Section: Discussionmentioning

confidence: 99%

“…Albrecht et al [23] reported a sensitivity of 53.2% and a specificity of 60%. Yamamoto et al [30] compared ductoscopy and galactography in 65 patients. In these authors' study, intraductal anomalies were detected by galactography in 89.1%, by ductoscopy in 97.4%, and in 97.5% of the cases with both methods combined.…”

Section: Discussionmentioning

confidence: 99%

Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

et al. 2014

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“…For detecting intraductal lesions, ductoscopy was as sensitive and as specific as the other tests. In 65 patients with nipple discharge, Yamamoto et al [29] evaluated galactography and ductoscopy for detecting intraductal anomalies and found the following sensitivities: galactography 89.1%, ductoscopy 97.4%, both methods combined 97.5%. Diagnostic ductoscopy rarely leads to complications as pointed out by Beechey-Newman et al [30].…”

Section: Discussionmentioning

confidence: 99%

Nipple Discharge: Role of Ductoscopy in Comparison with Standard Diagnostic Tests

Albrecht

Thele²,

Grunwald³

et al. 2013

Oncol Res Treat

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Background: This study aims to assess the role of ductoscopy for detecting intraductal anomalies in patients with nipple discharge in comparison to conventional tests and to find an effective combination of both approaches. Materials and Methods: Prior to duct excision, ductoscopy was performed in 97 women. Histologic and all other diagnostic results were compared. Sensitivity, specificity, and efficiency were calculated for all methods. These parameters were also calculated for all possible test combinations in 12 patients who had completed all tests. Results: Breast sonography reached the highest sensitivity (64.1%) and efficiency (64%); mammography had the highest specificity (100%). The sensitivity of ductoscopy was 53.2%, its specificity 60%, and its efficiency 55.1%. Among combinations of all methods, the combination ductoscopy + galactography was the most sensitive (80%). Mammography, magnetic resonance imaging, and ductoscopy were each 100% specific. Ductoscopy was the most efficient (75%) single method. Conclusion: Ductoscopy is a valuable test for diagnosing intraductal lesions in patients with nipple discharge. It is more efficient than conventional tests in patients undergoing all tests.

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“…In previous investigations of asymptomatic women with nipple discharge, a definitive diagnosis of malignancy was not possible in approximately 70% of cases (8,9) ; however, cytology has been improved by new techniques such as "duct lavage" and "duct endoscopy" (ductoscopy). (10)(11)(12) These newer techniques are designed to examine the abnormal cells that travel from the ducts to the nipple. Moreover, biological markers such as carcinoembryonic antigen (CEA) or human epidermal growth factor receptor (HER)2 have also been analyzed in liquid specimens, (13)(14)(15) although this technique is associated with a high false-negative rate.…”

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confidence: 99%

High levels of DJ‐1 protein in nipple fluid of patients with breast cancer

et al. 2012

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As we have previously demonstrated that some breast cancer cell lines secrete DJ-1 protein, we examined here whether breast cancer cells secrete DJ-1 protein in vivo. To this end, the levels of DJ-1 protein present in 136 specimens of nipple fluid was examined by enzyme-linked immunosorbent assay (ELISA). The average concentration of DJ-1 protein detected in diluted samples from 47 patients with invasive ductal carcinoma (IDC) was 22.4 ng/mL, while it was 18.6 ng/mL in 26 patients with ductal carcinoma in situ (DCIS). In contrast, the average DJ-1 concentration in samples from 63 women with benign lesions was 2.7 ng/mL, demonstrating that higher DJ-1 protein levels were detected in nipple fluid in the presence of cancer cells than in the presence of benign lesions (P < 0.0001). When a cut-off level of 3.0 ng/mL was applied, the higher level of DJ-1 was shown to be of significant clinical value for predicting the presence of breast cancer (85.9% specificity, 75% sensitivity; P < 0.0001). Multivariate logistic analysis that included established factors such as nipple discharge cytology, ductoscopic cytology, and carcinoembryonic antigen level further showed that the level of DJ-1 protein alone is of significant value for predicting the presence of breast cancer. Immunohistochemistry and in situ hybridization also showed that the low expression of DJ-1 protein, despite high mRNA expression, was significantly correlated with high DJ-1 protein levels in the nipple fluid. These data indicate that breast cancer cells secrete DJ-1 protein in vivo, and that its level is a potential indicator of breast cancer in patients with nipple discharge. (Cancer Sci 2012; 103: 1172-1176 N ipple discharge is a common complaint among women that is classified as normal or abnormal depending on features such as laterality, cyclic variation, quantity, or color.(1-3)Although the majority of cases of nipple discharge are due to benign conditions such as intraductal papilloma, ductal ectasia, or plasma cell mastitis, approximately 10-20% of cases are attributable to malignant conditions such as ductal carcinoma in situ (DCIS), or the early clinical stages of invasive ductal and/or lobular carcinoma. (4,5) While it has been proposed that patients with nipple discharge should undergo biopsy or subareolar exploration based on the presence or absence of a palpable mass, less invasive, non-surgical methods can also be applied in these cases. (6,7) The cytological evaluation of nipple discharge obtained directly from the nipple is widely used for clinical examination. In previous investigations of asymptomatic women with nipple discharge, a definitive diagnosis of malignancy was not possible in approximately 70% of cases (8,9) ; however, cytology has been improved by new techniques such as "duct lavage" and "duct endoscopy" (ductoscopy).(10-12) These newer techniques are designed to examine the abnormal cells that travel from the ducts to the nipple. Moreover, biological markers such as carcinoembryonic antigen (CEA) or human epidermal growth fac...

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A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge

Abstract: Ductography and fiberoptic ductoscopy are useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.

Cited by 70 publications

References 8 publications

Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

Nipple Discharge: Role of Ductoscopy in Comparison with Standard Diagnostic Tests

High levels of DJ‐1 protein in nipple fluid of patients with breast cancer

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