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Stellenwert der Duktoskopie in der Mammadiagnostik

The value of ductoscopy in breast diagnostics

Der Gynäkologe Aims and scope

Zusammenfassung

Die Mamillensekretion ist ein häufig assoziiertes (je nach histologischem Befund 1–33%) Symptom bei Brusterkrankungen, das Karzinomrisiko wird dabei mit 1,3–47% angegeben. Die Sekretion der weiblichen Brustdrüse ist eine besondere diagnostische und therapeutische Herausforderung, denn die Vielzahl der diagnostischen Verfahren (Inspektion, Palpation, Zytologie, Mammographie, Galaktographie, Sonographie einschließlich Duktsonographie, MRT, Duktallavage) lassen nicht immer eine Dignitätsdifferenzierung (maligne vs. benigne) zu. Alle bisher eingesetzten Methoden sind indirekte Verfahren zur Darstellung des Milchgangssystems und intraduktaler Prozesse. Mit der minimal-invasiven endoskopischen Milchgangsspiegelung (Duktoskopie, syn. Galaktoskopie) steht erstmalig eine Methode zur Verfügung, die eine direkte Visualisierung intraduktaler Veränderungen bei pathologischer Sekretion zulässt. Die ungezielte Milchgangsexstirpation könnte durch eine gezielte Probeentnahme unter duktoskopischer Sicht bald der Vergangenheit angehören. Die Machbarkeit der Duktoskopie ist grundsätzlich erwiesen, ihr Stellenwert in der Diagnosekette bei Mamillensekretion wird derzeit weltweit geprüft. In Deutschland wird sie zunehmend eingesetzt, zunächst aber noch als zusätzliches Diagnostikum auf experimenteller Basis. Der unkritische breite Einsatz dieser neuen Methode kann vor dem Vorliegen valider Ergebnisse im Rahmen von Studien aktuell noch nicht empfohlen werden.

Abstract

Breast diseases are frequently associated with nipple discharge. Depending on the histology of the underlying process, this occurs with a frequency of 1–33%. Cancer risk from nipple discharge is reported to be anywhere from 1.3% to 47%. It therefore represents a real diagnostic challenge, especially in view of the fact that the various diagnostic methods (inspection, palpation, cytologic analysis, mammography, galactography, ultrasonography including ductal evaluation, MRI, ductal lavage) cannot always elucidate whether the respective lesion is benign or malignant. All common standard diagnostic techniques take an indirect approach to visualizing the duct system and potential intraductal lesions, whereas ductoscopy (galactoscopy) is a minimally invasive technique permitting direct visualization of intraductal anomalies in cases of pathologic nipple discharge. The remaining methods will frequently lead to “blind” open biopsies (duct excision). With targeted biopsies under ductoscopic visualization, however, “blind” duct excision may become a method of the past. The feasibility and practicability of ductoscopy have been proven. At present, studies are being conducted worldwide, aimed at clarifying the role of ductoscopy as part of the diagnostic tree in the evaluation of nipple discharge. Before valid study results become available, one should caution against the indiscriminate, widespread use of this new method.

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Ohlinger, R., Paepke, S., Jacobs, V.R. et al. Stellenwert der Duktoskopie in der Mammadiagnostik. Gynäkologe 39, 538–544 (2006). https://doi.org/10.1007/s00129-006-1847-9

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