Mammary ductoscopy and follow‐up avoid unnecessary duct excision in patients with pathologic nipple discharge

Liu, Miao; Guo, Giagia; Xie, Fang; Wang, Siyuan; Yang, Houpu; Wang, Shu

doi:10.1002/jso.23972

Cited by 12 publications

(10 citation statements)

References 35 publications

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“…Liu et al showed that intraductal lesions are found on ductoscopy in 63.2% of patients with PND [14]. Intraductal papillomas are benign breast lesions covered by the epithelial and myoepithelial cell layers; they account for 1% to 2% of breast neoplasias and 10% of benign tumors [15, 16].…”

Section: Discussionmentioning

confidence: 99%

“…Al Sarakbi et al [20] graded lesions (D0–D5) based on the degree of suspicion for malignancy of a given lesion. A grading system devised by Makita does not precisely correspond with histologic diagnosis, while Al Sarakbi’s system requires the expertise of a surgeon rather than an objective description [14]. Our study specifies the detailed objective ductoscopy features that are closely related to malignancy of a lesion.…”

Section: Discussionmentioning

confidence: 99%

“…However, Kamali recognized the possibility of retained papilloma tissue using this modality. Kamali’s study found that the disease is usually underestimated, and disease progression is not hindered, by ductoscopic biopsy [14]. Researchers showed that the incidence of cancer evolving from the location of the pathological duct in the polypoid-solitary, multiple-lesion, superficial, no-lesion, and unclassified types is 8.5%, 19.0%, 31.6%, 7.2%, and 21.9%, respectively [25].…”

Section: Discussionmentioning

confidence: 99%

“…Atypical papillomas coexist with carcinoma in 22% to 67% of cases; therefore, ductal papillomectomy is inadequate treatment for intraductal papillomas with ADH [26]. Liu et al state that all intraductal lesions found by ductoscopy should undergo duct resection [14]. Both ductal papillomectomy and microdochectomy have limitations that require further discussion.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic value of endoscopic appearance during ductoscopy in patients with pathological nipple discharge

Han¹,

Li²,

Han³

et al. 2017

BMC Cancer

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BackgroundTo explore the features of ductoscopic appearance that may be diagnostic in patients with pathologic nipple discharge (PND) and to discuss the diagnostic criteria for intraductal tumors.MethodsWe reviewed 247 patients with PND but without a palpable mass who were evaluated using either surgical biopsy or excision. Data concerning patient age, duration of discharge, discharge color, and the details of endoscopic appearance were analyzed according to the pathological results.ResultsThe postoperative diagnosis in 61 patients (24.70%) was a nonmass lesion, and 186 patients (76.52%) had an intraductal tumor. Among those with intraductal lesions, 10 patients (4.05%) had a malignant tumor, including 4 (1.62%) with ductal carcinoma in situ and 6 (2.43%) with invasive ductal carcinoma. On univariate analysis, patients of older age with spontaneous and bloody discharge were more likely to suffer from intraductal lesions. On logistic regression analysis, bloody nipple discharge, morphology, and a broad lesion base revealed by ductoscopy showed a statistically significant correlation with malignancy (p = 0.001, p < 0.001, p = 0.022, respectively).ConclusionsBoth clinical features and endoscopic appearance are significant for the precise diagnosis of an intraductal lesion seen on ductoscopy. The endoscopic features of bloody discharge, morphology, and a broad lesion base are independent risk factors for malignancy and represent new criteria for the diagnosis of patients with PND.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3288-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic value of endoscopic appearance during ductoscopy in patients with pathological nipple discharge

Han¹,

Li²,

Han³

et al. 2017

BMC Cancer

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“…In the present series, only 60 (27.9%) patients underwent surgery after (attempted) ductoscopy (Figure 3), much less than previously described. 22,28,30,31 The most prominent reason to perform surgery was suspicious findings during ductoscopy. The most common indications for postductoscopy surgery were persistence and recurrence of PND.…”

Section: Mando Dyko Filipe Et Almentioning

confidence: 99%

Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience

Filipe

Waaijer

Pol

et al. 2020

Clinical Breast Cancer

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Ductoscopy is a minimally invasive technique that is currently used to detect, and sometimes remove, lesions that cause pathologic nipple discharge (PND). This study shows that ductoscopy is an alternative for surgery in patients with PND that have negative conventional imagery for breast cancer. Additionally, this study shows that ductoscopy has a high sensitivity, specificity, and negative predictive value for the detection of breast cancer in patients with PND with negative conventional imagery. Introduction: Pathologic nipple discharge (PND) is, after palpable lumps and pain, the most common breast-related reason for referral to the breast surgeon and is associated with breast cancer. However, with negative mammography and ultrasound, the chance of PND being caused by malignancy is between 5% and 8%. Nevertheless, most patients with PND still undergo surgery in order to rule out malignancy. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization. The aim of this study was to evaluate (interventional) ductoscopy as an alternative to surgery in patients with negative conventional imaging. Materials and Methods: All patients with PND referred between 2010 and 2017 to our hospital for ductoscopy were retrospectively analyzed. Ductoscopy procedures were performed under local anesthesia in the outpatient clinic. The follow-up period was at least 3 months, and the primary outcome was the number of prevented surgical procedures. Furthermore, we evaluated possible complications after ductoscopy (infection and pain). Results: A total of 215 consecutive patients undergoing ductoscopy were analyzed. In 151 (70.2%) patients, ductoscopy was successful. In 102 procedures, an underlying cause for PND was visualized, of which 34 patients could be histologically proven and 82 patients treated. Sixty of the 215 patients were eventually operated, 8 owing to suspicious findings during ductoscopy, 42 owing to persistent PND, and 10 because of recurrent PND. In 7 patients, a malignancy was found (5 of them classified as suspicious at dusctoscopy). No serious side effects were seen. Conclusion: Ductoscopy can be safely used as an alternative for surgery in the workup for PND.

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Nipple Discharge

2019

Breast Diseases

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Mammary ductoscopy and follow‐up avoid unnecessary duct excision in patients with pathologic nipple discharge

Abstract: Ductoscopy and follow-up were advantageous for selecting patients to undergo surgery or surveillance. The recurrence of PND after ductoscopy might be a strong predictor for having intraductal disease.

Cited by 12 publications

References 35 publications

Diagnostic value of endoscopic appearance during ductoscopy in patients with pathological nipple discharge

Diagnostic value of endoscopic appearance during ductoscopy in patients with pathological nipple discharge

Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience

Nipple Discharge

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