Selective microdochectomy after ductoscopic wire marking in women with pathological nipple discharge

Abstract

BackgroundTo investigate the diagnostic reliability of selective microdochectomy after direct ductoscopic wire marking of suspect lesions in patients with pathological nipple discharge.MethodsSelective microdochectomy due to pathological discharge was performed in 33 patients with mean age of 51.7 years. Ductoscopes of 0.9 and 1.1 mm in diameter with a channel for wire marking were used. Only patients without sonographic or mammographic correlation for the discharge were included. The pathologic mammary duct was wire marked and extirpated under direct visual guidance via the ductoscope. The histological results were compared with cytology, galactography and ductoscopy.ResultsIn 24 out of 33 cases (72%) an intraductal, epithelial proliferation was found histologically. The following sensitivities for intraductal, epithelial proliferations could be determined: cytology 4%, galactography 74%, and ductoscopy 78%.ConclusionThe method allows selective microdochectomy of the pathological duct and the intraductal proliferation under visual guidance. The resection volume can be reduced in contrast to the unselective ductectomy after injection of methylene blue.

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

“…The low number of cases in the analysis of combinations has to be taken into account. A retrospective multicenter study launched in 2006 addresses the diagnostic value and therapeutic role of ductoscopy in comparison to conventional tests [35,36]. We envision a future with precisely defined indications for ductoscopy and less frequent open biopsies.…”

Comparison of Ductoscopy, Galactography, and Imaging Modalities for the Evaluation of Intraductal Lesions: A Critical Review

“…The available limited number of publications indicates that the probability of a carcinoma is 0-5% in PND cases that are clinically and radiologically negative [35,67]. Concerning the appropriate diagnostic and treatment approach, the uncertainty remains for which cases MG and US do not report any pathological lesions; however, in this special patient group, surgery and close follow-up options could be combined in existing algorithms [4,35]. …”

“…With the efforts of researchers in the early 1990s, direct endoluminal visualization of the breast ducts has become possible [3]. In contrast to the initial rigid ductoscopes with a diameter of more than 1.5 mm, rapidly developing technology has given us the opportunity to use fiberoptic ductoscopes with smaller diameters (0.55-1.1 mm) [4]. …”

Endoscopic mammoductoscopy: current status and future development

“…В свою очередь, M. Hahn и соавт. на примере 33 исследований убедились, что точность эндоско-пической чреспротоковой маркировки ВПНО с по-мощью проволоки составляет 78,3%, а причинами неудач считают либо ложноположительную оценку выявленных изменений эндоскопистом, либо поте-рю патологического субстрата патогистологом [27].…”

“…При отсутствии или исчезновении данного признака и наличии множе-ственных разветвлений рекомендуют продвигаться по протоку большего диаметра, хотя M. Hahn и со-авт. в таких ситуациях прибегают к осмотру всех по-следующих протоков [27]. Если необходима ревизия нескольких протоковых ответвлений, отверстия уже осмотренных галактофоров маркируют красителя-ми или обозначают их на предварительно подготов-ленной картограмме [2,22].…”