Fiberoptic ductoscopy for patients with nipple discharge

Area of Science:

• Breast imaging and diagnostics
• Minimally invasive surgical techniques
• Oncology and pathology

Background:

• Breast carcinoma and precancer originate in the milk duct or lobule lining.
• Traditional methods for accessing ductal tissue include core biopsy and fine-needle aspiration.
• Fiberoptic ductoscopy (FDS) offers direct visual access to the breast's ductal system via the nipple orifice.

Purpose of the Study:

• To evaluate the efficacy of fiberoptic ductoscopy (FDS) in diagnosing intraductal lesions in women with nipple discharge.
• To analyze visual findings, cytological washings, and histopathology from FDS procedures.
• To determine the positive predictive value of FDS in identifying papillary lesions.

Main Methods:

• Ductoscopy was performed on 259 women presenting with nipple discharge.
• Visual findings from FDS were analyzed alongside cytological washings and subsequent histopathology.
• Lesion location, distance from the nipple, and characteristics of exfoliated ductal cells were assessed.

Main Results:

• Fiberoptic ductoscopy successfully detected intraductal papillary lesions in 92 (36%) women.
• Lesions identified included single papilloma (74%), multiple discrete papillomas (23%), and diffuse intraductal thickening (3%).
• The overall positive predictive value of FDS screening was 83%, increasing to 86% with positive ductal washings.

Conclusions:

• Fiberoptic ductoscopy (FDS) is a safe alternative to ductography for guiding breast surgery in cases of nipple discharge.
• FDS provides direct visualization and aids in the accurate diagnosis of intraductal abnormalities.
• The technique facilitates targeted biopsies and treatment planning for breast conditions.