Mammary ductoscopy: past, present, and future

Abstract

Mammary ductoscopy (MD) allows direct visual access to the mammary ducts, using fiberoptic microendoscopes inserted through the ductal opening onto the nipple surface. Therefore it has a potential role in the diagnosis and treatment of intraductal breast disease. This article describes the anatomy of the mammary ductal system, the early beginnings of MD, its ongoing evolution, and the need for further development for its future usage in increasing clinical indications. MD is a useful diagnostic adjunct in patients with pathological nipple discharge (PND) and can guide duct excision surgery. However, its potential use in the early detection of breast cancer, in guiding breast-conserving surgery (BCS) for cancer, and in the therapeutic ablation of intraductal disease, as well as in guiding risk-reducing strategies among high-risk women, requires further research and evaluation. The development of a biopsy kit that obtains adequate microbiopsy samples for histological diagnosis under direct visualization will enhance the use of this technique by breast surgeons and radiologists. Future developments also include combining MD with molecular diagnostic markers and optical biopsy systems for the diagnosis of premalignant and early malignant disease, and combining MD with radiofrequency for curative ablation of intraductal lesions.

Diagnostic Value of Ductoscopy in the Diagnosis of Nipple Discharge and Intraductal Proliferations in Comparison to Standard Methods

“…Ductoscopy with a 0.55-0.95 mm diameter endoscope was conducted on 11 women with pathological nipple discharge without any intraoperative or postoperative complications, thereby showing a trend towards a further minimal-invasive diagnostic method. The use of additional technologies such as autofluorescence endoscope [25] or high-frequency ablation [9] extends the spectrum of minimal-invasive methods.…”

“…As such, in the work of Pereira and Mobkel [9], their account of the development of ductoscopy describes the evolution of this method and in particular its prospects for the future through the combination of endoscopy with molecular diagnostic markers or high-frequency ablation.…”

Evaluation of pain experienced during breast ductal endoscopy

“…Ductal endoscopy can produce enlarged, high-quality, real-time video images of tiny, previously unseen areas of the breast ductal system. [8][9][10][11] The initial results of ductal endoscopy in common clinical practice have been published only recently, with a limited number of patients. 10,12,13 However, the pain associated with this procedure has not been evaluated formally.…”

Mammographic image classification using histogram intersection

“…Galactography can be performed to visualize the breast ductal network by injecting a contrast agent into the lactiferous ducts of the breast. It is useful for visualizing early symptoms of papilloma or ductal ectasia, which cause spontaneous nipple discharge, without identifiable mammographic lesion [1].…”