Intraductal approach to the detection of intraductal lesions of the breast

Matsunaga, Tadaharu; Misaka, Takeharu; Hosokawa, Katsumasa; Taira, Shinichiro; Kim, Kyeongil; Serizawa, Hiromi; Akiyama, Hutoshi; Fujii, Masahiko

doi:10.1007/s10549-008-0203-2

Cited by 12 publications

(19 citation statements)

References 19 publications

(39 reference statements)

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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. In their study, cytologic lavage had a sensitivity of 82.8%.…”

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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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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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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“…IDBB provided a definite diagnosis of carcinoma in 42.9% of carcinoma cases [34]. Due to the difficulty in obtaining diagnostic specimens with IDBB, ductoscopically guided ductal lavage cytology is more sensitive and complementary to IDBB.…”

Section: Discussionmentioning

confidence: 99%

“…Cessation of nipple discharge (the therapeutic effectiveness) after the IDBB was found in 78.1% of intraductal papilloma patients who were followed for more than 3 years [34]. On the other hand, we know that 80-97% of cases with clinical signs of discharge were resolved after 11-G mammotome biopsies [78,79].…”

Section: Discussionmentioning

confidence: 99%

“…Carcinoma was identified in 37.5% of cases that were associated with peripheral papillomas [33]. Matsugana et al [34] showed the coexistence of intraductal papilloma in a major duct and ductal cancers separately in a peripheral duct. Denewer et al [27] found that the ductoscopic distance traveled was significantly related to histopathology.…”

Section: Ductoscopic Visual Diagnosis Sensitivity and Limitationsmentioning

confidence: 99%

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Comparison of Ductoscopy, Galactography, and Imaging Modalities for the Evaluation of Intraductal Lesions: A Critical Review

Sarıca¹,

Öztürk²,

Demirkurek

et al. 2013

Breast Care

277

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Background: Today, in cases of nipple discharge of unclear origin, the abundance of diagnostic procedures - a ‚diagnostic dilemma' - becomes apparent, because unequivocal indications and a current, standardized examination sequence are presently not available. The diagnostic workup of patients with nipple discharge usually includes the clinical history, physical examination, mammography, ultrasonography, galactography, and nipple discharge cytology, but not ductoscopy. Methods: In this review we analyze and discuss the possible role of ductoscopy in evaluating intraductal pathologies and its combined use with diagnostic imaging modalities. For this purpose, we reviewed and compared the results of the radiological, pathological, and surgical studies independently. Conclusions: Currently, there is no solitary accurate modality to reach our definitive purpose. Being aware of the capability of each diagnostic modality may take us closer to our target. Therefore, adjunct and appropriate use of multiple imaging modalities and ductoscopy is necessary to evaluate patients with nipple discharge.

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“…Advances in micro-catheters and duct endoscopy have enabled access to areas of the breast once considered remote [8]. Innovative surgical instrumentation allows excellent visualization of intraductal pathology with the ability for diagnostic biopsy under direct vision [9]. A potential clinical application that follows enhanced access to the breast microenvironment is the topical delivery of intraductal cytotoxic therapy [10].…”

Section: Introductionmentioning

confidence: 99%

The anatomy of fluid-yielding ducts in breast cancer

Twelves

Nerurkar

Osin

et al. 2011

Breast Cancer Res Treat

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The concept of an intraductal approach to evaluate the breast microenvironment assumes direct access to the cancer-containing duct. Central duct access to the cancer-affected lobe is essential if cytology or cell markers are to be useful indicators of pre-malignant change. Access to the cancer-bearing lobe would be less important if field change effects of malignant change were predominantly supra-lobar. The aim of this study was to determine how often duct lavage fluid drains the breast cancer-affected segment. 58 patients undergoing mastectomy for breast cancer were recruited among which 47 had at least one fluid-yielding duct. Following duct lavage, fluid-yielding ducts were perfused ex vivo with Polyurethane Elastomer (PU4ii) resin. Specimens were sliced sagittally, and the extent of resin perfusion and anatomical relationship to the cancer-affected segment was recorded. Computed tomography (CT) scanning was performed on selected mastectomies before cut-up for a feasibility study of 3D duct reconstruction. The median number of fluid-yielding ducts cannulated per cancer-affected breast was 2 (range 1-4). 35/47 (74%) mastectomy specimens were successfully cannulated for resin perfusion. 29/35 (83%) showed tracing of the cancer-affected duct system, 6/35 resin perfusions traced duct systems unaffected by cancer and 12/35 perfusions extravasated. The proportion of sagittal breast slices perfused by resin was 13-68% (median 43%). Volume rendering CT showed it is feasible to produce a simulated image of the perfused ducts. Duct access to the cancer-containing segment is feasible in the majority of patients. Fluid-yielding ducts proportionately drain a significant volume of the breast. Large symptomatic cancers may cause obstruction with distal collapse. Further quantitative study of breast perfusion CT scans may be helpful for estimating the volume fraction of breast tissue perfused by fluid-yielding ducts. The intraductal approach is a valid concept for biomarker assessment of cancer-containing breast segments.

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Intraductal approach to the detection of intraductal lesions of the breast

Cited by 12 publications

References 19 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

Comparison of Ductoscopy, Galactography, and Imaging Modalities for the Evaluation of Intraductal Lesions: A Critical Review

The anatomy of fluid-yielding ducts in breast cancer

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