title: Breast ductal endoscopy: how many procedures qualify?
abstract: BACKGROUND
  Breast ductal endoscopy is a relatively new diagnostic method with ever growing importance in the work-up of patients with bloody nipple discharge. The ability to perform ductal endoscopy is very important and useful for breast fellows. Learning curve in breast ductal endoscopy remains a terra incognita, since no systematic studies have addressed this topic. The purpose of this study is to determine the point (number of procedures during training) beyond which ductal endoscopy is successfully performed.
  
  
  RESULTS
  Ten breast fellows received training in our Breast Unit. For the training process, an ex vivo model was adopted. Fellows were trained on 20 surgical specimens derived from modified radical mastectomy for breast cancer. The target of the education program was to acquire proficiency in performing ductoscopy. The achievement of four consecutively successful ductal endoscopies was determined as the point beyond which proficiency had been achieved. The number of procedures needed for the achievement of proficiency as defined above ranged between 9 and 17 procedures. The median value was 13 procedures; i.e. 50% of trainees had achieved proficiency at the 13th procedure or earlier.
  
  
  CONCLUSIONS
  These pilot findings point to approximately 13 procedures as a point beyond which ductal endoscopy is successfully performed; studies on a larger number of fellows are nevertheless needed. Further research, focusing on the learning curves of different training models of ductal endoscopy, seems desirable.
authors: Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens; 114, Vas Sofias Ave, Athens 116 27, Greece. florazagouri@yahoo.co.uk
authors: Flora
authors: F
authors: Zagouri
authors: Theodoros N
authors: TN
authors: Sergentanis
authors: Georgia
authors: G
authors: Giannakopoulou
authors: Effrosyni
authors: E
authors: Panopoulou
authors: Dimosthenis
authors: D
authors: Chrysikos
authors: Garifallia
authors: G
authors: Bletsa
authors: John
authors: J
authors: Flessas
authors: George
authors: G
authors: Filippakis
authors: Alexandros
authors: A
authors: Papalabros
authors: Kostas J
authors: KJ
authors: Bramis
authors: George C
authors: GC
authors: Zografos