Intraductal laser ablation during ductoscopy in patients with pathological nipple discharge

Ductoscopy is a minimally invasive micro-endoscopic approach for direct visualization and removal of intraductal lesions of the breast. A challenge of ductoscopy is an adequate treatment of intraductal lesions by complete removal to prevent exploratory duct excision surgery. This study aimed to determine the in vivo feasibility of intraductal laser ablation during ductoscopy to remove intraductal lesions in patients suffering from pathological nipple discharge (PND).

A prospective, single-center diagnostic feasibility trial was conducted between October 2022 and November 2023, enrolling adult women with unilateral PND and no radiological suspicion of malignancy. Intraductal laser ablation was performed after incomplete intraductal biopsy using a Thulium laser.

Duct cannulation and subsequent ductoscopic exploration were successful in 21 patients revealing an intraductal lesion in 13 patients (61.9%). From these 13 patients, 9 patients (69.2%) underwent intraductal laser ablation due to a residual lesion after biopsy. Pathology of the removed intraductal lesions showed a papilloma in eight (88.9%) patients and a papilloma/DCIS combination in one patient (11.1%). Post-procedure, PND stopped in 77.8% of the patients (7/9). Two patients had recurrent PND complaints caused by a residual lesion.

Intraductal laser ablation during ductoscopy in patients with papillary lesions seems to be feasible and safe. The Thulium laser enables ablation of residual lesions and is therefore suitable for an immediate second intervention after ductoscopic removal of intraductal lesions. Further refinement and validation in a follow-up clinical trial are necessary to further assess its therapeutic efficacy.