Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to standard methods.
BACKGROUND
Ductoscopy is gaining increased importance in the diagnosis of nipple discharge of unclear origin and intraductal proliferation. For this reason we compared its diagnostic value and feasibility to standard diagnostic methods.


METHODS
Ductoscopy was compared to mammography, galactography, sonography, magnetic resonance imaging (MRI), nipple smear, fine needle aspiration cytology (FNAC), and high-speed core biopsy; feasibility, sensitivity, and specificity were investigated for each method.


RESULTS
71 ductoscopies were evaluated, which were followed up by open biopsies. Here, 3 invasive and 8 ductal carcinomas in situ were found, as well as 3 atypical ductal hyperplasias, 44 papillomas/papillomatoses, and 13 benign findings. Feasibility of ductoscopy was in this series 100%. Duct sonography showed the highest sensitivity (67.3%), followed by MRI (65.2%), galactography (56.3%), ductoscopy (55.2%), and FNAC (51.9%). The highest specificity was shown by FNAC, core biopsy, and galactography (each 100.0%), followed by mammography (92.3%), nipple smear (77.8%), ductoscopy, and duct sonography (each 61.5%); the lowest specificity was displayed by MRI (25.0%).


CONCLUSIONS
The results confirm that ductoscopy can be performed within the same range of sensitivity and specificity as other techniques. In order to make conclusive statements about ductoscopy, especially in order to precisely define the indications for this method, a prospective multicenter study was initiated.
Grunwald
Susanne
S
Department of Obstetrics and Gynecology, Ernst Moritz Arndt University, Greifswald, Germany.
Heyer
Hans
H
Paepke
Stefan
S
Schwesinger
Günther
G
Schimming
Anette
A
Hahn
Markus
M
Thomas
Anke
A
Jacobs
Volker R
VR
Ohlinger
Ralf
R
D000328:Adult; D000368:Aged; D001706:Biopsy; D001941:Breast Diseases / Q000175:diagnosis / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating; D002455:Cell Division / Q000502:physiology*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004724:Endoscopy; D005260:Female; D005687:Galactorrhea / Q000209:etiology* / Q000473:pathology; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology; D008875:Middle Aged; D009558:Nipples / Q000473:pathology; D018300:Papilloma, Intraductal / Q000175:diagnosis* / Q000473:pathology; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity