Abstract
PurposeAutofluorescence is an image enhancement technique used for the detection of cancer precursor lesions in pulmonary and gastrointestinal endoscopy. This study evaluated the feasibility of addition of autofluorescence to ductoscopy for the detection of intraductal breast cancer precursor lesions.MethodsAn autofluorescence imaging system, producing real-time computed images combining fluorescence intensities, was coupled to a conventional white light ductoscopy system. Prior to surgery, ductoscopy with white light and autofluorescence was evaluated under general anaesthesia in women scheduled for therapeutic or prophylactic mastectomy. Endoscopic findings in both modes were compared, marked and correlated with histology of the surgical specimen.ResultsFour breast cancer patients and five high-risk women, with a median age of 47 years (range 23–62) were included. In autofluorescence mode, two intraductal lesions were seen in two breast cancer patients, which had an increase in the red-to-green fluorescence intensity compared with the surrounding tissue. One lesion had initially been missed by white light ductoscopy but was clearly visible in subsequent autofluorescence mode. One endoscopic finding was classified as suspicious by white light, but was negative in autofluorescence mode and showed normal histology.ConclusionsThis study demonstrates for the first time the in vivo feasibility of autofluorescence ductoscopy to detect pathologically confirmed breast cancer precursor lesions in both breast cancer patients and high-risk women that were occult under white light.
Highlights
Breast cancer is, with 523,000 new cases a year, the most common type of cancer and accounts for 138,000 deaths a year in Europe [1]
From a prospective feasibility study in patients affected by breast cancer and in women with a known mutation in BRCA1 or BRCA2, we report for the first time the in vivo feasibility of autofluorescence to detect breast cancer precursor lesions by autofluorescence ductoscopy, confirmed by histology of the subsequently performed mastectomy
Inserted intraductal marker macroscopically showed extraductal diffusion from the ducts with perforations, without impairing microscopic localization (Fig. 4). This exploratory study indicates that autofluorescence ductoscopy is technically feasible in both breast cancer patients and high-risk women, with successful cannulation in 8 of 9 (89%) women
Summary
With 523,000 new cases a year, the most common type of cancer and accounts for 138,000 deaths a year in Europe [1]. Hereditary breast cancer accounts for up to 5–10% of all breast cancers with two high-penetrance genes (BRCA1 and BRCA2) responsible for about 16% of the familial risk of breast cancers, associated with a 60–80%. An appealing approach would be to target breast cancer precursors originating from the epithelial lining of the breast ducts through ductoscopy. This is a minimally invasive microendoscopic technique, which makes real-time visualisation of the milk ducts of the breast possible.
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