Gradient index ductoscopy and intraductal biopsy of intraductal breast lesions.
OBJECTIVE
Breast duct endoscopy is increasingly used for evaluation of intraductal disease. We have investigated a new rigid instrument for ductoscopy and intraductal biopsy of pathologic lesions.


METHODS
From 2002 to 2006, ductoscopy was performed in 111 women with breast cancer or pathologic nipple discharge. A rigid gradient index microendoscope (diameter .7 mm) was used for all examinations in combination with a specially developed needle for intraductal vacuum-assisted biopsy. Ductoscopy and intraductal biopsy were correlated with ductal cytology and histopathology of the resection specimen.


RESULTS
Ductoscopy identified intraductal lesions in 41% of the patients with breast cancer presenting as red patches, microcalcifications, or ductal obstruction. Compared with patients with a normal ductoscopy, patients with pathologic ductoscopy had a significantly higher risk of extensive intraductal carcinoma (71% versus 16%, P < .05). Ductal cytology showed only a few cases with severe cytologic atypia or malignant cells in cases with ductoscopic abnormalities. Intraductal vacuum-assisted biopsy yielded diagnostic material in 89% of 36 patients with nipple discharge and papillomatous lesions. Histology of the resection specimen confirmed the diagnosis in all cases (26 papillomas, 2 in situ carcinomas, and 2 invasive ductal carcinomas). In contrast, ductal cytology showed only moderate correlation with histopathology.


CONCLUSIONS
Ductoscopy is a useful supplement for the standard radiological workup of breast cancer especially in patients with extensive intraductal carcinoma. Ductoscopic vacuum-assisted biopsy is a new and effective technique for intraductal biopsy under visual control.
Hünerbein
Michael
M
Department of Surgery and Surgical Oncology, Charite Campus Buch, Universitätsmedizin Berlin and Helios Hospital, 13122 Berlin, Germany. michael.huenerbein@charite.de
Dubowy
Anna
A
Raubach
Matthias
M
Gebauer
Bernard
B
Topalidis
Theodorus
T
Schlag
Peter
P
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D019723:Endoscopes; D004724:Endoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged