224: Auto Fluorescence-Ductoscope: A New Instrument for In Vivo Detection of Intraductal Malignancies in the Breast

Abstract

Ductoscopy of breast ducts has been used for several years worldwide as mainly diagnostic tool for intraductal lesions. The principle of auto fluorescence can add additional visual information and help distinguish between benign and malignant lesions. In cooperation between PolyDiagnost, RICHARD-WOLF-Endoscopes and Frauenklinik (OB/GYN) of Technical University Munich, the first prototype of an auto fluorescence ductoscope was developed and in an initial procedure clinically evaluated. Experimental diagnostic procedure to exclude intraductal malignancy. Dept. of Senology, university clinic. A female patient, 55 years, with left-sided suspicious nipple discharge. Auto fluorescence ductoscopy on ducts of left breast. The auto fluorescence ductoscope has 30,000 pixel resolutions, a 0.4 mm irrigation channel and only 1.2 mm outer diameter. It is reusable, build in modular concept and can be gas sterilized. After local anesthesia was applied, nipple dilatation was performed and the ductoscope introduced. The duct walls were inspected in standard fashion in white light mode. With a switch at the light source, auto fluorescence mode at defined wave length is switched on. Now body’s own molecules reflect fluorescence light, normal tissue at full rate and lesions at reduced rate. A sophisticated data modification turns all non-benign lesions gradually red on the monitor, giving instant visual information in white light mode previously not seen. This newly developed instrument proved to be successful in the initial procedure. The wavelength threshold can be adjusted. Being able to visualize malignant lesions in vivo during an endoscopic procedure using body’s own auto fluorescence can broaden the indication and spectrum of application for ductoscopy tremendously, eventually as screening method for high-risk cancer patients in the future. An early detection of intraductal malignancy of the breast with intraductal endoscopy would offer a lesser invasive diagnostic option, could shorten time from diagnosis to start of therapy at a lower stage of disease and therewith could contribute to patients’ survival and outcome.