Minimalinvasive Diagnostik sezernierender Brusterkrankungen durch Milchgangsendoskopie

Grunwald, S.; Öhlinger, R.; Euler, U.; Kiechle, Marion; Plattner, Birgit; Fischer, Tünde; Warm, Mathias; Hahn, Markus; Jacobs, Volker R.; Paepke, S.

doi:10.1055/s-2005-918226

Cited by 8 publications

(12 citation statements)

References 13 publications

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“…The technique has the shortcoming that it cannot clarify if any observed duct narrowing is in- or extrinsic [2,11]. It achieved a sensitivity of 81.3% and a specificity of 44.4% in our study.…”

Section: Discussionmentioning

confidence: 79%

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Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

et al. 2014

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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.

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Section: Discussionmentioning

confidence: 79%

“…Conventional imaging and cytologic diagnostics provide only indirect information on the ducts. Which duct is affected cannot be specified [11]. Ductoscopy can directly depict intraductal lesions and shows other pathologies indirectly, i.e.…”

Section: Introductionmentioning

confidence: 99%

Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

et al. 2014

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“…The assessment of ductal obstructions is limited because the method cannot make a definitive distinction between intra- and extraductal processes [3]. Data vary widely in earlier publications.…”

Section: Discussionmentioning

confidence: 99%

“…It can also detect periductal processes leading to obstruction. Visualization extends from directly beyond the orifice of the duct well into the periphery [3]. Endoscopic appearance can predict the histological diagnosis [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Conventional diagnostics comprise indirect tests such as mammography, breast sonography, magnetic resonance imaging (MRI), and galactography. Another indirect method, cytologic analysis of material obtained by nipple smears or ductal lavage, fails to identify the involved duct [3]. Ductoscopy is the first test capable of assessing intraductal lesions directly.…”

Section: Introductionmentioning

confidence: 99%

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Nipple Discharge: Role of Ductoscopy in Comparison with Standard Diagnostic Tests

Albrecht

Thele²,

Grunwald³

et al. 2013

Oncol Res Treat

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Background: This study aims to assess the role of ductoscopy for detecting intraductal anomalies in patients with nipple discharge in comparison to conventional tests and to find an effective combination of both approaches. Materials and Methods: Prior to duct excision, ductoscopy was performed in 97 women. Histologic and all other diagnostic results were compared. Sensitivity, specificity, and efficiency were calculated for all methods. These parameters were also calculated for all possible test combinations in 12 patients who had completed all tests. Results: Breast sonography reached the highest sensitivity (64.1%) and efficiency (64%); mammography had the highest specificity (100%). The sensitivity of ductoscopy was 53.2%, its specificity 60%, and its efficiency 55.1%. Among combinations of all methods, the combination ductoscopy + galactography was the most sensitive (80%). Mammography, magnetic resonance imaging, and ductoscopy were each 100% specific. Ductoscopy was the most efficient (75%) single method. Conclusion: Ductoscopy is a valuable test for diagnosing intraductal lesions in patients with nipple discharge. It is more efficient than conventional tests in patients undergoing all tests.

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Stellenwert der Duktoskopie in der Mammadiagnostik

et al. 2006

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Die Mamillensekretion ist ein häufig assoziiertes Symptom bei Brusterkrankungen, dessen Frequenz in Abhängig-keit vom feingeweblichen Befund mit zwischen 1 und 33 angegeben wird [32]. Das Karzinomrisiko bei Mamillensekretion wird mit 1,3-47 angegeben [9, 40, 45, 59]. Die Sekretion der weiblichen Brustdrüse stellt eine besondere diagnostische und therapeutische Herausforderung dar, denn die Vielzahl der diagnostischen Verfahren (Inspektion, Palpation, Zytologie, Mammographie, Galaktographie, Sonographie einschließlich Duktsonographie, MRT, Duktallavage) lassen nicht immer eine Dignitätsdifferenzierung (maligne vs. benigne) zu. Alle bisher eingesetzten diagnostischen Methoden sind indirekte Verfahren zur Darstellung des Milchgangssystems und seiner intraduktalen Prozesse. Mit der minimal-invasiven endoskopischen Milchgangsspiegelung (Duktoskopie, syn. Galaktoskopie) steht erstmalig eine Methode zur Verfügung, die eine direkte Visualisierung intraduktaler Veränderungen bei pathologischer Sekretion zulässt. Während die anderen Verfahren oft in die "blinde" offene Biopsie mün-den, könnte diese durch eine gezielte Probeentnahme (PE) unter duktoskopischer Sicht bald der Vergangenheit angehören.Die Machbarkeit der Duktoskopie ist grundsätzlich erwiesen, ihr Stellenwert in der Diagnosekette bei einer Mamillensekretion wird derzeit weltweit geprüft. In Deutschland wird sie in den letzten Jahren zunehmend eingesetzt, zunächst aber noch als zusätzliches Diagnostikum auf experimenteller Basis. Der unkritische breite Einsatz dieser neuen Methode kann vor dem Vorliegen valider Ergebnisse im Rahmen von Studien noch nicht empfohlen werden.Während der Schwangerschaft und Stillzeit ist eine klare bzw. milchige Sekretion, meist beidseitig, physiologisch. Außerhalb dieser Zeit ist jede Sekretiongleich ob ein-oder beidseitig, serös oder blutig, spontan oder auf leichten Druckabklärungsbedürftig.

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Minimalinvasive Diagnostik sezernierender Brusterkrankungen durch Milchgangsendoskopie

Cited by 8 publications

References 13 publications

Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study

Nipple Discharge: Role of Ductoscopy in Comparison with Standard Diagnostic Tests

Stellenwert der Duktoskopie in der Mammadiagnostik

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