Skip to main content

Advertisement

Log in

Mammary Ductoscopy for Evaluation of Nipple Discharge

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Most breast cancers originate in the ductal epithelium with normal cells progressing to atypia and finally to carcinoma. Ductoscopy enables one to visualize and sample the ductal epithelium and therefore identify early changes cytologically. This report describes our experience with mammary ductoscopy as a tool for evaluation of nipple discharge at Beth Israel Medical Center.

Methods

A prospective review of all patients who have undergone ductoscopy for evaluation of persistent nipple discharge was performed. The Acueity ductoscopy system with .9-mm scope and a video monitor with ×60 magnification were used. Brush biopsy samples and lavage fluid were obtained from some patients and were sent for cytologic analysis. A subset of patients underwent ductoscopically guided duct excision.

Results

Ninety-three patients underwent ductoscopic evaluation of 110 ducts. Of these, 67 patients had abnormal findings and therefore underwent ductoscopically guided duct excision. The remaining 26 patients (28%) had normal ductoscopic examinations. The depth at which intraductal abnormalities were visualized was from 3 to 8 cm with an average of 4.4 cm for cancer cases and from 1 to 10 cm with an average of 4.5 cm for papillomas. Forty-two patients were diagnosed with papilloma/papillomatosis, six patients were diagnosed with atypical papilloma/atypical ductal hyperplasia/atypical lobular hyperplasia, and six patients were diagnosed with cancer. Of the six patients diagnosed with cancer, 67% had normal breast imaging, and other than nipple discharge, 67% had normal breast examinations.

Conclusion

Mammary ductoscopy is a useful tool in the evaluation of patients with nipple discharge. Although the most common cause of nipple discharge is an intraductal papilloma, nipple discharge can be the presenting symptom for cancer. Our experience revealed a papilloma rate of 45% (42 of 93), cancer rate of 6.5% (6 of 93), and an atypia rate of 6.5% (6 of 93) among the patients with nipple discharge. Mammary ductoscopy allows for accurate visualization, analysis, and excision of intraductal abnormalities. Many deeper intraductal abnormalities could be missed by blind surgical excision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Shao ZM, Liu Y, Nguyen M. The role of the breast ductal system in the diagnosis of cancer [review]. Oncol Rep 2001; 8:153–6.

    PubMed  CAS  Google Scholar 

  2. Shao ZM, Nguyen M. Nipple aspiration in diagnosis of breast cancer. Semin Surg Oncol 2001; 20:175–80.

    Article  PubMed  CAS  Google Scholar 

  3. Sparks CA. Using ductoscopy to detect breast mass at an early stage. AORN J 2002; 76:851–4.

    Article  PubMed  Google Scholar 

  4. Gong G, DeVries S, Chew KL, et al. Genetic changes in paired atypical and usual ductal hyperplasia of the breast by comparative genomic hybridization. Clin Cancer Res 2001; 17:2410–4.

    Google Scholar 

  5. Wrensch MR, Petrakis NL, King EB, et al. Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid. Am J Epidemiol 1992; 135:130–41.

    PubMed  CAS  Google Scholar 

  6. Shen KW, Wu J, Lu JS, et al. Fiberoptic ductoscopy for patients with nipple discharge. Cancer 2000; 89:1512–9.

    Article  PubMed  CAS  Google Scholar 

  7. Shen KW, Wu J, Lu JS, et al. Fiberoptic ductoscopy for breast cancer patients with nipple discharge. Surg Endosc 2001; 15:1340–5.

    Article  PubMed  CAS  Google Scholar 

  8. Love SM, Barsky SH. Breast-duct endoscopy to study stages of cancerous breast disease. Lancet 1996; 348:997–9.

    Article  PubMed  CAS  Google Scholar 

  9. Mokbel K, Elkak AE. The evolving role of mammary ductoscopy. Curr Med Res Opin 2002; 18:30–2.

    Article  PubMed  Google Scholar 

  10. Matsunaga T, Ohta D, Misaka T, et al. Mammary ductoscopy for diagnosis and treatment of intraductal lesions of the breast. Breast Cancer 2001; 8:213–21.

    Article  PubMed  CAS  Google Scholar 

  11. Makita M, Akiyama F, Gomi N, et al. Endoscopic classification of intraductal lesions and histological diagnosis. Breast Cancer 2002; 9:220–5.

    PubMed  Google Scholar 

  12. Dietz JR, Kim JA, Malycky JL, et al. Feasibility and technical consideration of mammary ductoscopy in human mastectomy specimens. Breast J 2000; 6:161–5.

    Article  PubMed  Google Scholar 

  13. Okazaki A, Okazaki M, Asaishi K, et al. Fiberoptic ductoscopy of the breast: a new diagnostic procedure for nipple discharge. Jpn J Clin Oncol 1991; 21:188–93.

    PubMed  CAS  Google Scholar 

  14. Okazaki A, Hirata K, Okazaki M, et al. Nipple discharge disorders: current diagnostic management and the role of fiber-ductoscopy. Eur Radiol 1999; 9:583–90.

    Article  PubMed  CAS  Google Scholar 

  15. Dooley WC. Routine operative breast endoscopy for bloody nipple discharge. Ann Surg Oncol 2002; 9:920–3.

    Article  PubMed  Google Scholar 

  16. Kim JA. Mammary ductoscopy—current and future applications (breast cancer and benign disease). Available at: http://www.cancernews.com/data/Article/236.asp. Accessed June 16, 2008

  17. Cabioglu N, Hunt KK, Singletary SE, et al. Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. J Am Coll Surg 2003; 196:354–64.

    Article  PubMed  Google Scholar 

  18. Falkenberry SS. Nipple discharge. Obstet Gynecol Clin North Am 2002; 29:21–9.

    Article  PubMed  Google Scholar 

  19. Van Zee KJ, Perez GO, Minnard E, et al. Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge. Cancer 1998; 82:1874–80.

    Article  PubMed  Google Scholar 

  20. Baitchev G, Gortchev G, Todorova A, et al. Intraductal aspiration cytology and galactography for nipple discharge. Int Surg 2003; 88:83–6.

    PubMed  CAS  Google Scholar 

  21. Yamamoto D, Shoji T, Kawanishi H, et al. A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge. Breast Cancer Res Treat 2001; 70:103–8.

    Article  PubMed  CAS  Google Scholar 

  22. Dietz JR, Crowe JP, Grundfest S, et al. Directed duct excision by using mammary ductoscopy in patients with pathological nipple discharge. Surgery 2002; 132:582–8.

    Article  PubMed  Google Scholar 

  23. Dunn JM, Lucarotti ME, Wood SJ, et al. Exfoliative cytology in the diagnosis of breast disease. Br J Surg 1995; 82:789–91.

    Article  PubMed  CAS  Google Scholar 

  24. Grunwald S, Heyer H, Paepke S, et al. Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to standard methods. Onkologie 2007; 30:243–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Edna Kapenhas-Valdes MD.

Additional information

Poster presentation at the 29th Annual Symposium of American Society of Breast Diseases, April 14–16, 2005, Las Vegas, Nevada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kapenhas-Valdes, E., Feldman, S.M., Cohen, JM. et al. Mammary Ductoscopy for Evaluation of Nipple Discharge. Ann Surg Oncol 15, 2720–2727 (2008). https://doi.org/10.1245/s10434-008-0012-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0012-1

Keywords

Navigation