3086: Diagnostic value of breast duct sonography and ductoscopy—an analysis of 86 cases

Abstract

Objectives: Benign conditions are the most frequent cause of nipple discharge, but malignant and precancerous lesions, such as ductal papilloma and papillomatosis, need to be ruled out. This study aims to evaluate the value of ductoscopy.Methods: Between 1999 and May 2005, 86 ductoscopies were completed in 71 patients with uni- or bilateral nipple discharge after excluding extramammary etiologies. Nipple discharge had been present in 76 breasts. Preoperative noninvasive and minimal-invasive tests were compared with ductoscopy and open biopsy results. In 71 ductoscopies, histological results were available for comparison. Histologic assessment revealed 13 benign lesions, 44 papillomas, five precursor lesions, six DCIS and three invasive carcinomas.Results: Breast duct endoscopy was successfully completed in all 86 cases, galactography in only 18 cases. Only mammography and duct sonography reached statistical significance with respect to detecting abnormal tissue. All techniques except MRI reached satisfactory sensitivities and specificities. Only duct sonography and ductoscopy had sensitivity values greater than 60%.Conclusions: Sonography and ductoscopy are similarly sensitive and specific for detecting intraductal lesions. A more precise assessment of ductoscopy will require further studies. In order to increase the detection rate of in-situ carcinomas, endoscopic techniques for obtaining intraductal biopsies should be improved and be used more frequently. Objectives: Benign conditions are the most frequent cause of nipple discharge, but malignant and precancerous lesions, such as ductal papilloma and papillomatosis, need to be ruled out. This study aims to evaluate the value of ductoscopy. Methods: Between 1999 and May 2005, 86 ductoscopies were completed in 71 patients with uni- or bilateral nipple discharge after excluding extramammary etiologies. Nipple discharge had been present in 76 breasts. Preoperative noninvasive and minimal-invasive tests were compared with ductoscopy and open biopsy results. In 71 ductoscopies, histological results were available for comparison. Histologic assessment revealed 13 benign lesions, 44 papillomas, five precursor lesions, six DCIS and three invasive carcinomas. Results: Breast duct endoscopy was successfully completed in all 86 cases, galactography in only 18 cases. Only mammography and duct sonography reached statistical significance with respect to detecting abnormal tissue. All techniques except MRI reached satisfactory sensitivities and specificities. Only duct sonography and ductoscopy had sensitivity values greater than 60%. Conclusions: Sonography and ductoscopy are similarly sensitive and specific for detecting intraductal lesions. A more precise assessment of ductoscopy will require further studies. In order to increase the detection rate of in-situ carcinomas, endoscopic techniques for obtaining intraductal biopsies should be improved and be used more frequently.