A Second Ductoscopy Procedure in Patients with Recurrent and Persistent Pathological Nipple Discharge

Area of Science:

• Breast Surgery
• Minimally Invasive Procedures
• Diagnostic Imaging

Background:

• Pathological nipple discharge (PND) often leads to surgery due to limitations of standard radiological imaging.
• Ductoscopy offers direct intraductal visualization but an unsuccessful first attempt can still result in unnecessary surgical intervention.
• This study investigates the utility of a second ductoscopy in managing persistent PND without suspicious radiological findings.

Purpose of the Study:

• To evaluate the effectiveness of a second ductoscopy procedure in patients with recurrent or persistent PND.
• To determine the rate of preventable surgical procedures following a second ductoscopy attempt.
• To assess the diagnostic yield of repeat ductoscopy in cases of initial technical failure.

Main Methods:

• Retrospective analysis of 17 patients who underwent two ductoscopy procedures between 2010 and 2017.
• The second ductoscopy was performed following an unsuccessful first attempt due to technical issues.
• Primary outcome measured was the number of surgeries that could have been avoided.

Main Results:

• A second ductoscopy was performed on 17 patients; the first attempt failed to visualize the ductal tree in 4 (23.5%).
• Pathological nipple discharge (PND) resolved in 10 patients (58.8%) after the second procedure, avoiding surgery.
• Of the 7 patients who still had PND, subsequent surgery revealed papilloma (5) or ductal carcinoma in situ (1).

Conclusions:

• A second ductoscopy is a valuable tool for patients with persistent PND after an initial failed attempt.
• Repeating the procedure can prevent unnecessary surgery in approximately 59% of cases.
• This approach enhances diagnostic accuracy and patient management for pathological nipple discharge.