Minimally invasive approach to diseases of the breast and contemporary factors affecting breast cancer surgery

Abstract

Dit proefschrift werd (mede) mogelijk gemaakt met financiële steun van TTW-KWF, Van Herk Ventures, Leander Healthcare B.V en SeederDeBoer . ContentsChapter 1. General outlinePart I: Intraductal diagnosis of breast lesions.Chapter 2.Network meta-analysis for the diagnostic approach to pathologic nipple discharge Chapter 3.Interventional ductoscopy as an alternative for major duct excision or microdochectomy in gomen suffering pathologic nipple discharge: a single-center experience. Chapter 4.Detection of breast cancer precursor lesions by autofluorescence ductoscopy.Chapter 5. Feasibility of narrow band imaging ductoscopy, intraductal biopsy and intraductal laser ablation in patients with pathological nipple discharge and patients with a high-risk for the development of breast cancer: a study protocol.Part II: Minimally invasive treatment of diseases of the breast. Chapter 6.Cost-effectiveness analysis, systematic review and meta-analysis of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge. 10Chapter 1 General Outline Pathological nipple dischargePathologic nipple discharge (PND) is defined as spontaneous unilateral bloody or serous discharge from a single orifice of the nipple. It is a common breast-related complaint for referral due to its association with breast cancer. [1][2][3][4] However, when ultrasound and mammography are negative, 95% of the PND have a benign cause (duct ectasias and intraductal papillomas). 5,6 Diagnostic work-up of PNDMammography and breast ultrasound are the commonly used diagnostic tools for the detection of breast cancer. However, when PND is the only symptom, they often miss breast cancer. 7 Conversely, magnetic resonance imaging (MRI) has a high true positive rate for the detection of breast cancer but at the same time shows a high number of false positive results in patients with PND. 8,9 Treatment strategies for PND Microdochectomy and major duct excision are currently the most common used methods to rule out malignancy and treat patients with PND without radiological signs of malignancy. 5,7,8 These surgical procedures are performed under general anesthesia and are associated with scarring, which may result in breastfeeding difficulties in fertile women and loss of sensitivity in the nipple. 10General outline