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Duct endoscopy and endoscopic biopsy in the evaluation of nipple discharge
M Makita1, G Sakamoto, F Akiyama
1Department of Pathology, Cancer Institute, Tokyo, Japan.
Abstract:
Microdochectomy is usually performed on patients with nipple discharge caused by intraductal proliferative lesions, such as intraductal papilloma and carcinoma. But this operation often sacrifices large amounts of normal mammary gland even when the lesion is a benign intraductal papilloma a few millimeters in diameter. We have developed duct endoscopy for the mammary duct system, and have reliably performed biopsies for intraductal proliferative lesions intraductally. From June 1989 to April 1990, we examined 22 cases by duct endoscopy, and performed endoscopic biopsy in 16 cases. The method of endoscopic biopsy is as follows. First, a bougie is inserted, without anesthesia other than Xylocaine jelly, into the orifice of the duct to enlarge it. Second, the outer cylinder and the inner needle are inserted; then the inner needle is removed, and the endoscope is inserted. After examination, the outer cylinder is moved up to the lesion to be biopsied and the endoscope is taken out. Then a sample is taken into the outer cylinder by aspiration. We diagnosed 10 cases of benign lesion and 5 cases of malignant lesion by cytological and/or histological examination. In conclusion, endoscopic biopsy, aided by duct endoscopy, is a useful and harmless diagnostic procedure in the evaluation of nipple discharge.
Insights
Endoscopic biopsy using duct endoscopy allows for minimally invasive diagnosis of nipple discharge causes. This technique accurately identifies benign and malignant intraductal lesions, preserving healthy breast tissue.
Area of Science:
- Surgical Oncology
- Diagnostic Imaging
- Gastroenterology (Endoscopy)
Background:
- Microdochectomy, a common procedure for nipple discharge, often involves extensive tissue removal.
- Intraductal proliferative lesions, including papilloma and carcinoma, are frequent causes of nipple discharge.
- There is a need for less invasive diagnostic methods to evaluate these lesions.
Purpose of the Study:
- To introduce and evaluate the efficacy of duct endoscopy for mammary duct systems.
- To assess the utility of endoscopic biopsy in diagnosing intraductal proliferative lesions.
- To compare endoscopic biopsy with traditional methods for nipple discharge evaluation.
Main Methods:
- Development of a duct endoscopy system for the mammary duct.
- Performance of endoscopic biopsy under local anesthesia (Xylocaine jelly).
- Procedure involves bougie insertion, outer cylinder and needle placement, endoscope insertion, lesion localization, and sample aspiration.
Main Results:
- Duct endoscopy was performed on 22 cases, with endoscopic biopsy in 16 cases.
- Accurate diagnosis of 10 benign and 5 malignant lesions was achieved through cytological and/or histological examination.
- The procedure demonstrated reliability in obtaining diagnostic samples.
Conclusions:
- Endoscopic biopsy, facilitated by duct endoscopy, is a valuable diagnostic tool for nipple discharge.
- This minimally invasive approach aids in the accurate evaluation of intraductal lesions.
- The technique is considered useful and harmless for diagnosing the cause of nipple discharge.