Interventional ductoscopy in patients with pathological nipple discharge
L Waaijer1, P J van Diest2, H M Verkooijen3
1Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
The British Journal of Surgery
|October 9, 2015
Summary
Interventional ductoscopy successfully diagnosed and treated pathological nipple discharge (PND) in most patients, often avoiding surgery. Further optimization is needed for definitive diagnosis, especially in malignancy cases.
Area of Science:
- Gynecology
- Surgical Endoscopy
Background:
- Pathological nipple discharge (PND) typically requires surgery for diagnosis and treatment.
- Ductoscopy, an endoscopic technique, shows promise in improving PND diagnosis and potentially reducing surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of interventional ductoscopy in managing patients with pathological nipple discharge (PND).
Main Methods:
- A prospective study involving consecutive PND patients without suspected malignancy.
- Ductoscopic extraction was used for intraductal lesions; surgery was reserved for suspicious findings or patient preference.
- Outcomes assessed included cannulation success, lesion detection/removal, symptom resolution, and surgical avoidance.
Main Results:
- Ductoscope introduction was successful in 87% of patients, visualizing abnormalities in 65%.
- Surgery was avoided in 68% of patients, with 49% experiencing symptom resolution at follow-up.
- Malignancy was diagnosed in 5% of cases, with some missed by ductoscopy or initial surgery.
Conclusions:
- Interventional ductoscopy is feasible for PND management and can help avoid surgery in many cases.
- Endoscopic lesion removal is not always definitive, and malignancy can be an underlying cause.
- Optimization of ductoscopic instruments is necessary for improved histological diagnosis.
