Stereotaxic Core-Needle Biopsy in Assessing Intraductal Pathologic Findings at Ductography

Abstract

Objective:The purpose of this study was to analyze the capabilities of ductography (DG) to navigate stereotactic core-needle biopsy (sCNB) for localizing and differentiating intraductal benign and malignant proliferations of the breast in patients with pathological nipple discharge (PND). Materials and Methods:Patients underwent physical, radiological, ultrasound, endoscopic and histopathological examinations. Results:The study included 183 patients. In 51, traditional DG was performed and in eight patients DG was performed using endoscopic mammoductoscopy (EMDS). A routine ductectomy labeled with methylene blue or propylene thread was performed in 81 patients. In 77 cases, a ductectomy was performed after double wire marking of intraductal proliferations (IDP) through the nipple and through the skin. In 26 patients, a preoperative sCNB under guidance of DG was performed. After sCNB 23/26 patients had benign IDP and three (11.5%) had invasive cancer. Breast surgery confirmed histology to be the gold standard in all patients, with the exception of 7 (26.9%) under the age of 45 years with benign IDP. These patients had watchful waiting and after 35 months of follow-up no signs of malignant growth were detected.DG was characterized by high (87.9%) sensitivity and low (33.3%) specificity. False positive rate was 25.9% and the cause was peripheral location of IDP (>3 cm from the nipple) in 57.1% and inadequate excision with leaving them outside the resection. Conclusion:This initial study on sCNB under the guidance of traditional or selective DG reports promising findings. Further studies are needed to determine whether preoperative histological assessment of pathologic intraductal lesions at DG would reduce the number of open surgeries with benign histology at sCNB.