Fiberoptic ductoscopy findings in women with and without spontaneous nipple discharge.
BACKGROUND
Fiberoptic ductoscopy (FD), which allows direct visualization of the breast ductal lumen, is performed in women with and without spontaneous nipple discharge (SND). Previous reports suggested that cytologic evaluation of SND may be falsely interpreted as containing malignancy. The purpose of the current study, which was performed prospectively, was to determine whether ductoscopic findings were different in women with versus without SND, and to assess the implications of the differences in SND versus non-SND samples regarding the role of FD in assessing whether a woman has breast carcinoma.


METHODS
Data were collected on the distance traveled by the ductoscope, visual observations, pathology, cytology, epithelial and foam cell quantity, and image analysis for ploidy, hypertetraploidy, and S-phase fraction.


RESULTS
Of 100 FD specimens, 60 were from breasts without SND and 40 were from breasts with SND. Intraductal visual observations (P < or = 0.0002), pathologic findings in the resected specimen (P < or = 0.001), and quantity of epithelial cells (P=0.03) were influenced by the presence or absence of SND. Although one specimen from a benign breast was interpreted as cytologically malignant, every breast with both malignant cytology and aneuploidy contained cancer cells. A model incorporating cytology and SND was 92% sensitive and 60% specific in predicting which women had breast carcinoma.


CONCLUSIONS
There were pronounced differences in FD samples from women with and without SND. FD biologic parameters can be chosen to optimize breast carcinoma predictive sensitivity and specificity. SND cytology can present a diagnostic problem, suggesting the need for histologic confirmation before the initiation of therapy.
Sauter
Edward R
ER
Department of Surgery, University of Missouri-Columbia/Ellis Fischel Cancer Center, Columbia, Missouri 65212, USA. SauterE@health.missouri.edu
Ehya
Hormoz
H
Klein-Szanto
Andres J P
AJ
Wagner-Mann
Colette
C
MacGibbon
Brenda
B
D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000175:diagnosis / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003581:Cytodiagnosis / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism*; D011446:Prospective Studies; D012680:Sensitivity and Specificity