Elsevier

Journal of Minimally Invasive Gynecology

Volume 13, Issue 5, September–October 2006, Pages 418-423
Journal of Minimally Invasive Gynecology

Original article
Mammary ductoscopy for the evaluation of nipple discharge and comparison with standard diagnostic techniques

https://doi.org/10.1016/j.jmig.2006.05.004Get rights and content

Abstract

Study objective

To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques.

Design

Canadian Task Force classification III.

Setting

Interdisciplinary Breast Unit of a university hospital.

Patients

Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge.

Interventions

Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy.

Measurements and main results

Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n = 8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found.

Conclusion

Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.

Section snippets

Materials and methods

Our analysis includes an unselected series of continuous patients with nipple discharge and all data prospectively collected between April 2003 and April 2004. Initially, extramammary causes for nipple discharge were considered exclusion criterion and were ruled out. Subsequently, all patients with unilateral or bilateral nipple discharge underwent the variety of preoperative tests, such as mammography, breast ultrasonography, nipple smear, and minimally invasive diagnostics such as

Results

In this study 15 female patients were investigated. The average patient age was 49.9 years, range 30 to 74 years. Analysis included 20 breast examinations from 15 patients (10 patients with unilateral, 5 patients with bilateral nipple discharge). Nipple discharge was either reddish (n = 3; 15.0%), milky (n = 2; 10.0%), or green (n = 2; 10.0%), but mainly clear serous (n = 13; 65.0%).

Discussion

The comparison of different diagnostic tools for evaluation of unilateral or bilateral nipple discharge showed varying results for sensitivity and specificity (Table 1). The highest diagnostic value has ultrasonography with 76.5%, followed by galactography with 60.0%, ductoscopy with 56.3%, and nipple smear with only 33.3%. The analysis of the tests in our study demonstrates that ductoscopy, compared with the other 3 methods, leads to satisfactory results, although at this point and on the

Conclusions

The evaluation of ductoscopy compared with other standard diagnostics highlights the method’s diagnostic advantages compared with galactography. However, no current advantage was found in comparison to breast ultrasonography. Definitive conclusions regarding the advantages and disadvantages of ductoscopy mandate additional studies of all diagnostic modalities. Combining ultrasonography with ductoscopy and endoscopic biopsy as routine for nipple discharge could allow for reduction of the number

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