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Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge
Jill R Dietz1, Joseph P Crowe, Sharon Grundfest
1Departments of General Surgery and Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio ,USA.
Background:
Duct excision for pathologic nipple discharge (PND) often requires "blind" surgical resection. Intraoperative mammary ductoscopy can allow for direct visualization of intraductal abnormalities during surgical resection.
Methods:
We reviewed our experience with 119 patients with PND undergoing ductoscopy-directed duct excision. The variables that could interfere with a successful procedure were analyzed.
Results:
Cannulation of the discharging duct was successful in 105 of 119 (88%) of patients, and ductoscopy-directed duct excision could be performed in 104 of 119 (87%). A preoperative ductogram was obtained in 70 patients and was positive in 53 of 70 (76%). In this same group, ductoscopy was positive in 63 of 70 (90%). The pathologic diagnoses were as follows: cancer (5), papilloma (84), and hyperplasia (16), for an abnormal pathology yield of 88%. Hyperplasia and cancer were significant predictors of unsuccessful cannulation. In 22 patients, ductoscopy visualized multiple lesions or abnormalities beyond 4 cm.
Conclusions:
Mammary ductoscopy for PND is a safe, effective procedure that offers advantages of a high lesion localization rate and intraoperative guidance, therefore negating the need for a preoperative ductogram. Lesions deep within the ductal system can be identified and removed, which would likely have been missed by blind duct excision.