title: Office ductoscopy for surgical selection in women with pathologic nipple discharge.
abstract: BACKGROUND
  Pathologic nipple discharge (PND) is diagnosed clinically and managed by diagnostic duct excision (DDE). Mammary ductoscopy in the office setting may change this standard. We performed a prospective study to assess the utility of office ductoscopy for surgical selection in women with nipple discharge.
  
  
  METHODS
  Women with nipple discharge meeting at least 2 of 3 criteria of PND (spontaneous, single duct, bloody or serous) underwent office ductoscopy. Those showing papillomatous lesions underwent DDE in the operating room (surgical group, n = 38); if no lesion was present, women were followed clinically (observation group, n = 21).
  
  
  RESULTS
  A papillomatous lesion was identified in 79% of women with 3-criteria PND and in 21% with 2 criteria (P = .001). DDE yielded a proliferative lesion in 35 of 38 women (92%). Of the 38, 27 (71%) had papillomata, 2 (5%) had florid hyperplasia, and 6 (16%) had ductal carcinoma in situ (DCIS) on final pathology. Also, 11 women with papilloma and 1 with DCIS presented with 2-criteria PND. Ductoscopy findings were a better predictor of the presence of intraductal neoplasia (area under curve [AUC] 0.9, 95% confidence interval [95% CI] 0.8-0.98) compared with 3-criteria PND (AUC 0.7, 95% CI 0.6-0.8). The 21 women in the observation group did not develop signs of malignancy or need biopsy during a 48-month follow-up period.
  
  
  CONCLUSIONS
  Our findings suggest that office ductoscopy provides accurate surgical selection of women with nipple discharge and should be considered for women with 2 criteria of PND, and those with negative ductoscopy can be safely observed. These findings need confirmation in a larger study with longer follow-up.
authors.affiliation: Department of Surgery, Lynn Sage Breast Center, Northwestern Feinberg School of Medicine, Chicago, IL, USA. skhan@nmh.org
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
authors.forename: Amrit
authors.initials: A
authors.lastname: Mangat
authors.forename: Aeisha
authors.initials: A
authors.lastname: Rivers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Revesz
authors.forename: Barbara
authors.initials: B
authors.lastname: Susnik
authors.forename: Nora
authors.initials: N
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D010212:Papilloma / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies