title: Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge.
abstract: BACKGROUND
  Duct excision for pathologic nipple discharge (PND) often requires "blind" surgical resection. Intraoperative mammary ductoscopy can allow for direct visualization of intraductal abnormalities during surgical resection.
  
  
  METHODS
  We reviewed our experience with 119 patients with PND undergoing ductoscopy-directed duct excision. The variables that could interfere with a successful procedure were analyzed.
  
  
  RESULTS
  Cannulation of the discharging duct was successful in 105 of 119 (88%) of patients, and ductoscopy-directed duct excision could be performed in 104 of 119 (87%). A preoperative ductogram was obtained in 70 patients and was positive in 53 of 70 (76%). In this same group, ductoscopy was positive in 63 of 70 (90%). The pathologic diagnoses were as follows: cancer (5), papilloma (84), and hyperplasia (16), for an abnormal pathology yield of 88%. Hyperplasia and cancer were significant predictors of unsuccessful cannulation. In 22 patients, ductoscopy visualized multiple lesions or abnormalities beyond 4 cm.
  
  
  CONCLUSIONS
  Mammary ductoscopy for PND is a safe, effective procedure that offers advantages of a high lesion localization rate and intraoperative guidance, therefore negating the need for a preoperative ductogram. Lesions deep within the ductal system can be identified and removed, which would likely have been missed by blind duct excision.
authors.affiliation: Departments of General Surgery and Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio ,USA.
authors.forename: Jill R
authors.initials: JR
authors.lastname: Dietz
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Crowe
authors.forename: Sharon
authors.initials: S
authors.lastname: Grundfest
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.forename: Julian A
authors.initials: JA
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D010212:Papilloma / Q000473:pathology / Q000601:surgery; D044469:Racial Groups