title: Ductoscopy and intraductal vacuum assisted biopsy in women with pathologic nipple discharge.
abstract: BACKGROUND
  Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors.
  
  
  METHODS
  From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen
  
  
  RESULTS
  Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ.
  
  
  CONCLUSIONS
  Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.
authors.affiliation: Department of Surgery and Surgical Oncology, Charité Universitätsmedizin Berlin, Campus Berlin Buch and Helios Hospital, Buch, Berlin, Germany. huenerbein@rrk.charite-buch.de
authors.forename: Michael
authors.initials: M
authors.lastname: Hünerbein
authors.forename: Matthias
authors.initials: M
authors.lastname: Raubach
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gebauer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schneider
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schlag
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis; D003937:Diagnosis, Differential; D004724:Endoscopy; D005069:Evaluation Studies as Topic; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology*; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism*; D018300:Papilloma, Intraductal / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013396:Suction; D016217:Ultrasonography, Mammary; D014618:Vacuum