title: Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge.
abstract: OBJECTIVE
  In order to evaluate the diagnostic and therapeutic potential of mammary ductoscopy and watchful follow-up for treating bloody nipple discharge, we investigated the incidence of cancer evolving from the location related to the affected duct and the disappearance of nipple discharge.
  
  
  METHODS
  Between April 1998 and March 2008, we assessed 709 lesions among 624 patients without a diagnosis of malignancy at the time of 6 months after mammary ductoscopy. The median follow-up time was 5.5 years. We reviewed the subjects' charts retrospectively and investigated the dates on which discharge-related cancer was diagnosed and the disappearance of discharge was noted after the initial examination with mammary ductoscopy.
  
  
  RESULTS
  The incidence of cancer evolving from the location related to the pathological duct was 11 % (78/709). Nipple discharge disappeared in 480 (85.1 %) of the 564 followed up lesions, with the exception of 78 breast cancers and 67 resected benign lesions. The rate of disappearance for nipple discharge in the cases of intraductal papilloma at the first examination was 82.5 %. In cases in which no obvious lesions were observed on mammary ductoscopy, there was a 90 % probability that the nipple discharge would disappear, and the rate of evolving breast cancer in the cases of atypical papillary lesions at the first examination was significantly higher than that observed in the cases of intraductal papilloma, at 50 and 8.9 %, respectively.
  
  
  CONCLUSIONS
  Information revealed by mammary ductoscopy is useful for differentiating patients who should be subjected to intensive examinations and those who should expect disappearance of their discharge. Mammary ductoscopy and watchful follow-up can substitute microdochectomy in patients with bloody nipple discharge.
authors.affiliation: Department of Breast Surgical Oncology, Breast Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. mmakita@jfcr.or.jp.
authors.forename: Masujiro
authors.initials: M
authors.lastname: Makita
authors.affiliation: Department of Pathology, Cancer Institute, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Akiyama
authors.affiliation: Department of Diagnostic Radiology, Breast Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Gomi
authors.affiliation: Department of Breast Surgical Oncology, Breast Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwase
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009558:Nipples / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D018300:Papilloma, Intraductal / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery*; D011379:Prognosis; D057832:Watchful Waiting; D055815:Young Adult
keywords: Breast cancer; Endoscopic classification; Intraductal papilloma; Mammary ductoscopy; Microdochectomy; Nipple discharge