Abstract
BackgroundTo explore the features of ductoscopic appearance that may be diagnostic in patients with pathologic nipple discharge (PND) and to discuss the diagnostic criteria for intraductal tumors.MethodsWe reviewed 247 patients with PND but without a palpable mass who were evaluated using either surgical biopsy or excision. Data concerning patient age, duration of discharge, discharge color, and the details of endoscopic appearance were analyzed according to the pathological results.ResultsThe postoperative diagnosis in 61 patients (24.70%) was a nonmass lesion, and 186 patients (76.52%) had an intraductal tumor. Among those with intraductal lesions, 10 patients (4.05%) had a malignant tumor, including 4 (1.62%) with ductal carcinoma in situ and 6 (2.43%) with invasive ductal carcinoma. On univariate analysis, patients of older age with spontaneous and bloody discharge were more likely to suffer from intraductal lesions. On logistic regression analysis, bloody nipple discharge, morphology, and a broad lesion base revealed by ductoscopy showed a statistically significant correlation with malignancy (p = 0.001, p < 0.001, p = 0.022, respectively).ConclusionsBoth clinical features and endoscopic appearance are significant for the precise diagnosis of an intraductal lesion seen on ductoscopy. The endoscopic features of bloody discharge, morphology, and a broad lesion base are independent risk factors for malignancy and represent new criteria for the diagnosis of patients with PND.
Highlights
To explore the features of ductoscopic appearance that may be diagnostic in patients with pathologic nipple discharge (PND) and to discuss the diagnostic criteria for intraductal tumors
Of the 186 patients with intraductal lesions, mammographic abnormalities were present in 8.60% (16/186), and US abnormalities were present in 67.74% (126/186)
Clinicians are in great need of a precise evaluation system that uses endoscopic appearance to improve the diagnostic ability of ductoscopy
Summary
To explore the features of ductoscopic appearance that may be diagnostic in patients with pathologic nipple discharge (PND) and to discuss the diagnostic criteria for intraductal tumors. Pathologic nipple discharge (PND) is defined as unilateral, nonphysiologic nipple discharge from a single duct unit. This symptom is reported in 5% to 8% of breast-clinic consultations [1, 2]. Mammary fiberoptic ductoscopy is used worldwide as a standard method of diagnosis for PND; there is no consensus on the utility of evaluating the endoscopic appearance. The aim of this study is to Mammary fiberoptic ductoscopy was first described in 1989 as an effective examination for diagnosing the cause of nipple discharge in women [5, 6]. There are no definite criteria for diagnosing PND, and each examination has its limits
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