Mammary Ductoscopy for Evaluation of Nipple Discharge

Abstract

Mammary ductoscopy is a useful tool in the evaluation of patients with nipple discharge. Although the most common cause of nipple discharge is an intraductal papilloma, nipple discharge can be the presenting symptom for cancer. Our experience revealed a papilloma rate of 45% (42 of 93), cancer rate of 6.5% (6 of 93), and an atypia rate of 6.5% (6 of 93) among the patients with nipple discharge. Mammary ductoscopy allows for accurate visualization, analysis, and excision of intraductal abnormalities. Many deeper intraductal abnormalities could be missed by blind surgical excision.

Role of Galactography in the Early Diagnosis of Breast Cancer

“…However, the sonographic detection of DCIS is difficult. Other investigation modalities of PND include exfoliative cytology and mammary (or fiber optic) ductoscopy, although the sensitivity of cytology is low and only positive results have value [3,13], while mammary ductoscopy is an emerging technology that allows direct visualization and biopsy examination of the mammary ductal abnormalities [24,25]. …”

Mammary ductoscopy in the current management of breast disease

“…Moncrief et al [11] reported that 37.3% of patients undergoing ductoscopy had lesions more than 5 cm from the nipple. Kapenhas-Valdes et al [3] found that lesions were visualized from depths of 3 to 8 cm (average, 4.4 cm). Dooley [5] reported that the majority of lesions were found within 3 cm from the nipple, although some were identified as deep as 7.5 cm from nipple.…”

“…In addition, MD can be performed easily as an office or out-patient diagnostic procedure with application of a local anesthetic (commonly lidocaine or xylocaine) by topical gel to the nipple or by periareolar infiltration or infusion down the cannulated nipple duct. Instillation of a local anesthetic into the nipple ducts after cannulation facilitates relaxation of the major duct muscle sphincters [1][2][3].…”

“…1 The dissembled components of a 0.9-mm LaDuscope (PolyDiagnost GmbH, Pfaffenhofen, Germany) comprising a A fiberoptic scope, B disposable two-port cannula, C cannula sheath, D shifter, and E protective metal sheath for the fiberoptic to be used during sterilization lacrimal probe into the recently endoscoped lesion-containing duct. When disposable scopes are used, the sheath of the MD may be sutured in place and if not dislodged, will enable the pathologist to identify accurately the lesion of interest to the endoscopist [3]. It also is possible to inject methylene blue dye through the endoscope to mark the target duct for surgical excision.…”

“…For 11 cases in which intraductal thickening was found, the final histology showed hyperplasia in five cases, papilloma in two cases, ADH in two cases, DCIS in one case, and invasive cancer in one case. The prospective review by Kapenhas-Valdes et al [3] of 93 patients undergoing ductoscopy to evaluate nipple discharge found that 67 patients had abnormal ductoscopic findings and went on to have ductoscopically guided duct excision of 77 ducts. Visible pathologies included duct ectasia and hyperplasia in 17 ducts, papilloma in 48 ducts, ADH in 6 ducts, and cancer in 6 ducts.…”