SummaryBackground: According to the literature, ductoscopy is gaining increasing importance in the diagnosis of intraductal anomalies in cases of pathologic nipple discharge. In a multicenter study, the impact of this method was assessed in comparison with that of standard diagnostics. Patients and Methods: Between 09/2006 and 05/2009, a total of 214 patients from 7 German breast centers were included. All patients underwent elective ductoscopy and subsequent ductal excision because of pathologic nipple discharge. Ductoscopy was compared with the following standard diagnostics: breast sonography, mammography, magnetic resonance imaging (MRI), galactography, cytologic nipple swab, and ductal lavage cytology. The histological and imaging results were compared and contrasted to the results obtained from the nipple swab and cytologic assessment. Results: Sonography had the highest (82.9%) sensitivity, followed by MRI (82.5%), galactography (81.3%), ductoscopy (71.2%), lavage cytology (57.8%), mammography (57.1%), and nipple swab (22.8%). Nipple swabs had the highest (85.5%) specificity, followed by lavage cytology (85.2%), ductoscopy (49.4%), galactography (44.4%), mammography (33.3%), sonography (17.9%), and MRI (11.8%). Conclusion: Currently, ductoscopy provides a direct intraoperative visualization of intraductal lesions. Sensitivity and specificity are similar to those of standard diagnostics. The technique supports selective duct excision, in contrast to the unselective technique according to Urban. Therefore, ductoscopy extends the interventional/diagnostic armamentarium.

Background/Aim: The study aimed at investigating the correlation between ductoscopic and histopathological findings and clarify whether the former allow for accurate prediction of malignancy. Patients and Methods: The prospective national multi-center study covered a sample of 224 patients with pathologic nipple discharge. A total of 214 patients underwent ductoscopy with subsequent extirpation of the mammary duct. The ductoscopic findings were categorized according to shape, number, color and surface structure of lesions and vascularity and compared to the histological results and analyses. Results: Ductoscopy revealed lesions in 134 of 214 patients (62.2%). The criteria "multiple versus solitary lesion" differed significantly between malignant and benign lesions. All other criteria were not statistically significant. Malignant tumors were more frequently presented as multiple lesions, benign lesions or masses as solitary lesions (80% vs. 24.8%; p=0.018). Conclusion: The ductoscopic criterion "solitary vs. multiple lesion" appears to have a low diagnostic prediction of malignancy or benignity.Nipple discharge is a common symptom of breast disease. It represents the second leading common symptom after mastodynia for which most women appear in specialized breast departments/clinics (1). A total of 5-7% of all women going to a special breast clinic suffer of nipple discharge (2-4), which may be caused by a benign or malignant lesion. The incidence of pathologic nipple discharge and papilloma has been most frequently described (43-66% of cases), followed by ductal ectasia (15-20%) and carcinomas (10-28%) (1, 2, 4-7). In addition to anamnesis talk and physical examination, further diagnostic methods in cases of pathologic nipple discharge are necessary. These are ultrasound of the breast, mammography, galactography, smear of the nipple, ductal lavage and in some reasonable cases an MRI examination (5,8,9). The whole excision of the secretory duct by using a blue dye technique remains the gold standard for patients with conspicuous nipple discharge. Since the end of the eighties (1980), ductal endoscopy including ductoscopy and galactography is available for a direct visualisation of the small milk ducts (1). Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization (10). The most promising investigation technique of nipple discharge with unclear causes is actually ductoscopy (1, 2) and has already been 2185

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