Mammary ductoscopy for the evaluation of nipple discharge and comparison with standard diagnostic techniques.
OBJECTIVE
To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques.


METHODS
Canadian Task Force classification III.


METHODS
Interdisciplinary Breast Unit of a university hospital.


METHODS
Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge.


METHODS
Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy.


RESULTS
Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n=8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found.


CONCLUSIONS
Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.
Grunwald
Susanne
S
Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt-University, Greifswald, and Clinic of Minimally Invasive Surgery, Evangelic Hospital Hubertus, Berlin, Germany. susanne.grunwald@uni-greifswald.de
Bojahr
Bernd
B
Schwesinger
Gunther
G
Schimming
Annette
A
Kohler
Gunter
G
Schulz
Karen
K
Ohlinger
Ralf
R
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D001941:Breast Diseases / Q000150:complications / Q000175:diagnosis*; D004724:Endoscopy / Q000379:methods*; D005122:Exudates and Transudates / Q000166:cytology; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human; D008327:Mammography; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism*; D011237:Predictive Value of Tests; D012189:Retrospective Studies