Breast duct microendoscopy in nipple discharge: microbrush improves cytology

Beechey-Newman, N.; Kulkarni, Deepak; Kothari, Ashutosh; D’Arrlgo, C.; Culora, G.; Hamed, Hisham; Fentiman, Ian S.

doi:10.1007/s00464-005-0124-7

Cited by 18 publications

(19 citation statements)

References 15 publications

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“…This is an expected result, as the prevalence of depression is higher in females, with or without CKD [27]. Other demographic variables such as age, obesity, duration of disease, were similar in patients with and without elevated depressive symptoms.…”

Section: Discussionsupporting

confidence: 50%

Depressive Symptoms and Proinflammatory Cytokine Levels in Chronic Renal Failure Patients

Dervişoğlu¹,

Kır²,

Kalender³

et al. 2008

Nephron Clin Pract

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Background/Aims: Cytokine secretion is known to play an important role in the pathophysiology of depression, and levels of proinflammatory cytokines are increased in chronic renal failure (CRF) patients. The objective of this study was to examine the correlation between levels of proinflammatory cytokines in CRF patients and degree of depression. Methods: 31 patients on hemodialysis, 31 patients on continuous ambulatory peritoneal dialysis, and 31 conservatively managed chronic kidney disease (CKD) patients were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI), and ‘elevated symptoms of depression’ were defined as a BDI score ≧17. IL-6 and TNFα cytokine levels were measured by ELISA. Results: ‘Elevated symptoms of depression’ occurred in 37 of 93 patients (40%). IL-6 and TNFα levels were not significantly different among CRF patients with and without elevated depressive symptoms (p = 0.937 and p = 0.414, respectively). When analyzed by treatment subgroup, proinflammatory cytokine levels were not significantly different in patients with and without elevated symptoms of depression. Conclusion: In patients with CRF, elevated symptoms of depression were not associated with increased cytokine levels.

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Section: Discussionsupporting

confidence: 50%

Depressive Symptoms and Proinflammatory Cytokine Levels in Chronic Renal Failure Patients

Dervişoğlu¹,

Kır²,

Kalender³

et al. 2008

Nephron Clin Pract

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“…From their study and others, it is not a giant leap to conclude that intraluminal abnormalities in the ductal system have just as much need to undergo biopsy as the average palpable lump or radiographical (mammographic, ultrasound, or magnetic resonance imaging) lesion. 4,6,[8][9][10][11][12][13] But this relatively narrow view misses the greatest power of this new technology.We do not have mammogram and magnetic resonance imaging machines in our operating rooms to direct our surgical procedures. The best we can do is preoperative needle localization and postexcision specimen imaging.…”

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confidence: 99%

“…1 As techniques and equipment have evolved in the last 15 years, we now have several relatively simple submillimeter endoscopes that can be used to look within saline-distended larger ductal segments within the breast. [2][3][4][5][6] Valdes et al 7 demonstrate in their early experience with ductoscopy the ability to find and visualize intraductal lesions for excision. As with prior studies, they were impressed with the ability to identify histologically significant lesions that were relatively distant from the nipple, such as an 8-cmdeep ductal carcinoma-in-situ.…”

mentioning

confidence: 99%

“…Improving our intraoperative mapping of the suspicious lesions-especially if these are potentially ductal carcinoma-in-situ-can only further enhance our success at getting truly clear margins. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] We understand that many cancers are years in evolution. We should not be waiting to treat them until they are invasive and have the potential to spread from the breast.…”

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confidence: 99%

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Who Wants a Blind Breast Surgeon?

Dooley

2008

Ann Surg Oncol

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Mammary ductoscopy was introduced by Japanese surgeons in the early 1990s for the direct visualization of the source of bloody nipple discharge.1 As techniques and equipment have evolved in the last 15 years, we now have several relatively simple submillimeter endoscopes that can be used to look within saline-distended larger ductal segments within the breast.2-6 Valdes et al. 7 demonstrate in their early experience with ductoscopy the ability to find and visualize intraductal lesions for excision. As with prior studies, they were impressed with the ability to identify histologically significant lesions that were relatively distant from the nipple, such as an 8-cmdeep ductal carcinoma-in-situ. They clearly have increased the number of breast cancers identified before traditional radiographical imaging or clinical examination alone. From their study and others, it is not a giant leap to conclude that intraluminal abnormalities in the ductal system have just as much need to undergo biopsy as the average palpable lump or radiographical (mammographic, ultrasound, or magnetic resonance imaging) lesion. 4,6,[8][9][10][11][12][13] But this relatively narrow view misses the greatest power of this new technology.We do not have mammogram and magnetic resonance imaging machines in our operating rooms to direct our surgical procedures. The best we can do is preoperative needle localization and postexcision specimen imaging. Despite this, most breast surgery operations today are performed with the same intraoperative imaging tool that Halsted used: the surgeon's palpation alone. The last decade has seen a rapid increase in intraoperative ultrasonography use by dedicated breast surgeons to assist in better and more accurate excisions of small invasive cancers. Improving our intraoperative mapping of the suspicious lesions-especially if these are potentially ductal carcinoma-in-situ-can only further enhance our success at getting truly clear margins. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] We understand that many cancers are years in evolution. We should not be waiting to treat them until they are invasive and have the potential to spread from the breast. Finding cancers earlier and intervening sooner has been the mantra that has led to the dramatic decreases in breast cancer death rates in the last several years.Over the last decade, we have learned the importance of ellictable fluid from the nipple, especially in high-risk individuals. If we know someone is high risk and she is having breast surgery, should we not be certain that any intraductal lesions, related or unrelated to the target of the surgical procedure, are also adequately sampled? Can we perform a more accurate lumpectomy by actually mapping out the extent of the involved ductal system and either excising it all or excising the lesion and all associated intraluminal defects? When vascular surgeons are sewing on small blood vessels, is there any argument about putting on loops to make a better and smoother suture line closure? Although there are ma...

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“…The rationale of cancer detection is based on the recognition of informative breast lesions, which from a cytological point of view means recognizing malignant cells that have arisen from the ductal spaces [7]. Consequently, different types of technical procedures were tested, including microendoscopy, microbrush, or ductal washings, etc., with different performances [8,9,10] and different degrees of tolerance and perception of pain by women [11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Can Breast Nipple Fluid Collected with Automated Aspiration and Preserved in Based-Liquid Solution Improve the Cytological Samples?

Filassi

Zonta²,

Trinconi³

et al. 2013

Acta Cytologica

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Objective: Samples from breast nipples collected with the automated HALO™ Mamo Cito Test were studied in order to evaluate the cellularity for the diagnosis of breast cancer. Study Design: One hundred and fifty-nine asymptomatic women were prospectively examined. Women younger than 18 years, pregnant or lactating women, and women with a history of breast cancer, with previous radio- or chemotherapy and with nipple piercing were excluded from the study. Nipple samples from both breasts were collected. Results: In 107 (34.96%) of the 306 samples of nipple discharge analyzed by optical microscopy, adequate cellularity was observed after the HALO procedure. Cytological findings, previously categorized according to the National Health Service Breast Screening Program (NHSBSP), were grouped as unsatisfactory, benign, suspected for malignancy, and malignant. Of the cellular breast samples, 97.19% (104/107) were classified as benign, and 2.81% (3/107) were classified as suspicious for malignancy. In 199 cases there were samples without cells (65.03%). Most of the cells observed were easily recognized as well-preserved and adequately stained macrophages. None of the women reported discomfort with the nipple aspiration procedure. Conclusions: The results discussed here encouraged us to use samples collected automatically in routine procedures.

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Breast duct microendoscopy in nipple discharge: microbrush improves cytology

Abstract: Breast duct microendoscopy is an effective way of establishing the etiology of nipple discharge. The microbrush increases the sensitivity of cytology significantly.

Cited by 18 publications

References 15 publications

Depressive Symptoms and Proinflammatory Cytokine Levels in Chronic Renal Failure Patients

Depressive Symptoms and Proinflammatory Cytokine Levels in Chronic Renal Failure Patients

Who Wants a Blind Breast Surgeon?

Can Breast Nipple Fluid Collected with Automated Aspiration and Preserved in Based-Liquid Solution Improve the Cytological Samples?

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