Office Ductoscopy for Surgical Selection in Women with Pathologic Nipple Discharge

Khan, Seema A.; Mangat, Amrit; Rivers, Aeisha; Revesz, Elizabeth; Susnik, Barbara; Hansen, Nora M.

doi:10.1245/s10434-011-1791-3

Cited by 15 publications

(18 citation statements)

References 24 publications

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“…In previous investigations of asymptomatic women with nipple discharge, a definitive diagnosis of malignancy was not possible in approximately 70% of cases (8,9) ; however, cytology has been improved by new techniques such as "duct lavage" and "duct endoscopy" (ductoscopy). (10)(11)(12) These newer techniques are designed to examine the abnormal cells that travel from the ducts to the nipple. Moreover, biological markers such as carcinoembryonic antigen (CEA) or human epidermal growth factor receptor (HER)2 have also been analyzed in liquid specimens, (13)(14)(15) although this technique is associated with a high false-negative rate.…”

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High levels of DJ‐1 protein in nipple fluid of patients with breast cancer

et al. 2012

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As we have previously demonstrated that some breast cancer cell lines secrete DJ-1 protein, we examined here whether breast cancer cells secrete DJ-1 protein in vivo. To this end, the levels of DJ-1 protein present in 136 specimens of nipple fluid was examined by enzyme-linked immunosorbent assay (ELISA). The average concentration of DJ-1 protein detected in diluted samples from 47 patients with invasive ductal carcinoma (IDC) was 22.4 ng/mL, while it was 18.6 ng/mL in 26 patients with ductal carcinoma in situ (DCIS). In contrast, the average DJ-1 concentration in samples from 63 women with benign lesions was 2.7 ng/mL, demonstrating that higher DJ-1 protein levels were detected in nipple fluid in the presence of cancer cells than in the presence of benign lesions (P < 0.0001). When a cut-off level of 3.0 ng/mL was applied, the higher level of DJ-1 was shown to be of significant clinical value for predicting the presence of breast cancer (85.9% specificity, 75% sensitivity; P < 0.0001). Multivariate logistic analysis that included established factors such as nipple discharge cytology, ductoscopic cytology, and carcinoembryonic antigen level further showed that the level of DJ-1 protein alone is of significant value for predicting the presence of breast cancer. Immunohistochemistry and in situ hybridization also showed that the low expression of DJ-1 protein, despite high mRNA expression, was significantly correlated with high DJ-1 protein levels in the nipple fluid. These data indicate that breast cancer cells secrete DJ-1 protein in vivo, and that its level is a potential indicator of breast cancer in patients with nipple discharge. (Cancer Sci 2012; 103: 1172-1176 N ipple discharge is a common complaint among women that is classified as normal or abnormal depending on features such as laterality, cyclic variation, quantity, or color.(1-3)Although the majority of cases of nipple discharge are due to benign conditions such as intraductal papilloma, ductal ectasia, or plasma cell mastitis, approximately 10-20% of cases are attributable to malignant conditions such as ductal carcinoma in situ (DCIS), or the early clinical stages of invasive ductal and/or lobular carcinoma. (4,5) While it has been proposed that patients with nipple discharge should undergo biopsy or subareolar exploration based on the presence or absence of a palpable mass, less invasive, non-surgical methods can also be applied in these cases. (6,7) The cytological evaluation of nipple discharge obtained directly from the nipple is widely used for clinical examination. In previous investigations of asymptomatic women with nipple discharge, a definitive diagnosis of malignancy was not possible in approximately 70% of cases (8,9) ; however, cytology has been improved by new techniques such as "duct lavage" and "duct endoscopy" (ductoscopy).(10-12) These newer techniques are designed to examine the abnormal cells that travel from the ducts to the nipple. Moreover, biological markers such as carcinoembryonic antigen (CEA) or human epidermal growth fac...

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High levels of DJ‐1 protein in nipple fluid of patients with breast cancer

et al. 2012

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“…Khan et al, [10] grouped patients according to the number of positive criteria in their research of the value of South. Clin.…”

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Comparative analysis of minimally invasive Microductectomy versus Major Duct Excision in the diagnosis and treatment of patients with pathologic nipple discharge

Çetin¹

2017

South Clin Ist Euras

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Objective: The present study is a comparison of results in patients with pathological nipple discharge (PND) who underwent microductectomy and those who underwent major duct excision (MDE). Methods:This study included patients who underwent surgery in the clinic due to PND between October 2015 and October 2011. Data were collected via retrospective chart review. The patients were divided into 2 groups according to the type of surgery (Group Micro and Group Major). The demographic characteristics of the patients, the character of the discharge, preoperative imaging findings, preoperative cytological findings, postoperative pathological findings, and follow-up results were analyzed. Results:The records of a total of 78 patients were examined. Group Micro comprised 57 patients, and 21 were included in Group Major. The most frequently observed lesion in both groups was papillomatous lesion without atypia (Group Major: n=8, 38.1% and Group Micro: n=26, 45.6%). Premalignant lesion was detected in 17 patients (atypical ductal hyperplasia, papillomatous lesion with atypia, ductal carcinoma in situ, intraductal papillary carcinoma). Although the number of patients with a premalignant lesion in Group Major was greater than that seen in Group Minor, the difference was not significant (n=11, 19.3% and n=6, 28.6%, respectively; p=0.3). Conclusion:Conventional imaging and cytology techniques are usually insufficient in the diagnosis of PND. Therefore, surgery is frequently required in these patients. Microductectomy or MDE may be selected as the preferred surgical procedure. In this study, the results of the 2 procedures were found to be similar.

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“…Дополнительными преимуществами ЭМДС счи-тают возможность локализации и маркировки выяв-ленных, особенно периферически расположенных ВПНО, что способствует сокращению длительности хирургических операций, минимизации объема ре-зецируемой ткани, гарантированному и адекватному удалению патологического субстрата [12,13].…”

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“…К положительным характеристикам ЭМДС как методики в целом относят сравнительно низкую се-бестоимость, незначительную длительность проце-дуры, атравматичность, возможность проведения в амбулаторных условиях под местной анестезией [13,16,17].…”

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“…Наркоз при ЭМДС используют редко, и либо у эмоционально лабильных пациенток, либо непо-средственно в процессе оперативных вмешательств, когда проводят диафаноскопическую локализа-цию и маркировку периферически расположенных ВПНО [13,17]. Для местного обезболивания при-меняют аппликации анестезирующих гелей и ма-зей, околососковое или внутрипротоковое введение местных анестетиков.…”

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