Intraductal biopsy for diagnosis and treatment of intraductal lesions of the breast

Matsunaga, Tadaharu; Kawakami, Chika; Namba, Kiyoshi; Fujii, Masahiko

doi:10.1002/cncr.20657

Cited by 40 publications

(37 citation statements)

References 18 publications

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“…According to many studies, after duct excision surgery, PND patients with an initial pathological diagnosis of ‘benign or no abnormal findings' developed breast cancer [76,77]. Ductoscopic follow-up is controversial because of its high false-positive rate reaching 17% [7].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…However, this method only plays a restricted role as it does not provide access to the terminal duct lobular units that are often the origin of malignant lesions. The ductoscopic appearance of intraductal papillomas can range from red to yellow to ashen [37]. Papillomas can extend into the lumen of the milk duct as a polypoid mass where they present as solitary or multiple lesions - a benign mammary tumour in a single milk duct system.…”

Section: Papillomasmentioning

confidence: 99%

“…Papillomas can extend into the lumen of the milk duct as a polypoid mass where they present as solitary or multiple lesions - a benign mammary tumour in a single milk duct system. In rare cases, papillary lesions can occur in different milk duct systems, both unilateral and bilateral [37]. …”

Section: Papillomasmentioning

confidence: 99%

Benign Breast Tumours - Diagnosis and Management

et al. 2018

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With improvements in breast imaging, mammography, ultrasound and minimally invasive interventions, the detection of early breast cancer, non-invasive cancers, lesions of uncertain malignant potential, and benign lesions has increased. However, with the improved diagnostic capabilities comes a substantial risk of false-positive benign lesions and vice versa false-negative malignant lesions. A statement is provided on the manifestation, imaging, and diagnostic verification of isolated benign breast tumours that have a frequent manifestation, in addition to general therapy management recommendations. Histological evaluation of benign breast tumours is the most reliable diagnostic method. According to the S3 guideline and information gained from analysis of the literature, preference is to be given to core biopsy for each type of tumour as the preferred diagnostic method. An indication for open biopsy is also to be established should the tumour increase in size in the follow-up interval, after recurring discrepancies in the vacuum biopsy results, or at the request of the patient. As an alternative, minimally invasive procedures such as therapeutic vacuum biopsy, cryoablation or high-intensity focused ultrasound are also becoming possible alternatives in definitive surgical management. The newer minimally invasive methods show an adequate degree of accuracy and hardly any restrictions in terms of post-interventional cosmetics so that current requirements of extensive breast imaging can be thoroughly met.

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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.…”

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.…”

mentioning

confidence: 99%

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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Intraductal biopsy for diagnosis and treatment of intraductal lesions of the breast

Cited by 40 publications

References 18 publications

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

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

Benign Breast Tumours - Diagnosis and Management

Who Wants a Blind Breast Surgeon?

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