Use of ductoscopy as an additional diagnostic method and its applications in nipple discharge

About 1/10 of the patients apply to breast clinics with the complaint of nipple discharge (ND). Surgery is the most frequently preferred treatment method in case of suspicious ND. The contribution of ductoscopy to identify the patients who are candidates for surgery was evaluated and its role to limit the surgery was assessed.

From November 2005 to December 2010 430 patients with ND were assessed by 456 ductoscopic investigations and the results were analyzed. Complete ductoscopic evaluation was achieved in 84% of cases and 28 patients were offered surgery but did not accept (N.=355). Patients with bloody or serous discharges from a single duct were investigated by ductoscopy under local anesthesia as an office procedure. The patients were grouped according to discharge characteristics and the ductoscopic diagnoses.

A total of 223 patients had all three criteria of pathologic ND (PND: single duct, spontaneous and bloody/serous discharge). Twenty-two potential neoplastic or malignant lesion (PNML) and 79 papillomatous lesion (solitary or multiple papilloma) were identified. In 132 patients with just two of the PND criteria, 5 PNML and 18 papillomatous lesions were identified. Twenty-three patients with solitary papilloma that were removed by ductoscopic papillomectomy (DP) are followed up without surgery.

Ductoscopy helped to identify the patients who required surgical treatment and decreased the number of operations. DP was successfully performed in select group of patients who otherwise would have required surgical resection. Patients with normal ductoscopy findings and patients who were treated with DP successfully can be followed up without the need of surgery.