Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge

Abstract

Background Pathologic nipple discharge (PND) is a common complaint often associated with breast cancer. However, when ultrasound and mammography are negative, the chances of malignancy are lower than 5%. Currently, major duct excision and microdochectomy are often recommended to alleviate symptoms and definitely rule out malignancy, but can cause infections and breastfeeding problems. Ductoscopy is a minimally invasive endoscopy technique that allows visualization of the mammary ducts and may not only obviate surgery but also detect malignancy. The aim of this study was to determine quality of life (QOL) after ductoscopy in patients with PND. Materials and methods All PND patients referred for ductoscopy between 2014 and 2015 to our hospital were included. Ductoscopy procedures were performed under local anaesthesia in the outpatient clinic. Patients were asked to fill out questionnaires (Breast-Q, EQ-5D-5L and SF-36) on the day of ductoscopy, and after 2 weeks, 3 and 6 months. Additionally, we performed reliability analysis to determine if these questionnaires were suitable for PND patients. Results Fifty consecutive patients underwent ductoscopy of whom 47 patients participated in this study. One domain of SF-36 (vitality) varied significantly over time. Breast-Q, SF-36 and EQ-5D-5L showed that QOL after ductoscopy for PND was unaffected by ductoscopy. Success of the ductoscopy procedure was a significant predictor for satisfaction with the result domain. Conclusion Ductoscopy is a minimally invasive technique that does not seem to impact QoL of PND patients over time. Breast-Q, SF-36 and EQ-5D-5L seem to be suitable existing QOL tests for PND patients undergoing ductoscopy, whereas SF-36 would require modifications.

Ultrasound-Guided Vacuum-Assisted Breast Complete Duct Excision: A Novel Minimally Invasive Surgical Technique for Pathological Nipple Discharge

“…ND is classified as pathologic if it is spontaneous, unilateral, or bloody. Alternatively, serous, and clear discharge is usually associated with a tumor [12]. IDP, duct ectasia, carcinoma, and infection are common causes of PND.…”

“…Currently, conventional examinations for diagnosing and locating the cause of PND mainly include mammary fiberoptic ductoscopy, galactography, ND cytology, and ultrasonography. However, each of these modalities has certain limitations [11,12]. Limited by the outer optical fiber diameter and different mammary duct branching modes, the observation range of ductoscopy is mainly confined to the central mammary duct [13].…”