Routine operative breast endoscopy during lumpectomy.
BACKGROUND
Lumpectomy for the management of breast cancer is commonly directed by mammography or ultrasound. We hypothesized that fluid-producing ducts would likely connect to the site of the known cancerous or precancerous lesion and that endoscopic evaluation might reveal unsuspected additional disease.


METHODS
All women undergoing lumpectomy in a single surgeon's practice from January 2000 to August 2001 were evaluated for fluid production from the nipple at the time of lumpectomy. All fluid-producing ducts were cannulated and endoscoped with a 0.9-mm Acueity microendoscope.


RESULTS
Of the 201 patients (16 with atypical ductal hyperplasia, 52 with ductal carcinoma-in-situ, and 133 with stage 1 or 2 breast cancers), 150 (74.6%) could be successfully dilated and scoped. Additional lesions outside the anticipated lumpectomy were identified in 41% (n = 83) of cases. If successful, the chances for a positive margin for cancer decreased from 23.5% to only 5.0%. Endoscopy proved to be a useful adjunct in this series of patients because it identified all cases of extensive intraductal component in early-stage breast cancer.


CONCLUSIONS
Routine operative breast endoscopy can reduce the need for re-excision lumpectomy. It also finds substantially more cancerous and precancerous disease than anticipated by routine preoperative mammography and ultrasound.
Dooley
William C
WC
University of Oklahoma Breast Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. wcdooley@cox.net
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000601:surgery; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D011230:Precancerous Conditions / Q000601:surgery*