The Lobar Distribution of the Lesions in Breast Carcinoma: Ductoscopy and Surgery

Abstract

Breast ductoscopy is an evolving field of surgical technical expertise and a new method of access to the earliest premalignant and malignant lesions for breast cancer researchers. Clinical endoscopy has rapidly improved over the last 40 years and offered researchers and clinicians access to many epithelial surfaces at risk for cancer. In the early 1990s, with the advent of submillimeter endoscopes, this approach could finally be used to examine the breast ductal epithelium. In a period of less than 2 decades, we have through clinical use been able to make direct observations of anatomy and the relationship of anatomy to the processes of breast cancer carcinogenesis. Whether unifocal or multifocal, breast cancers seem to arise within only a single ductal tree. The grade and presence or absence of angiogenesis seem to be associated with lesions in radically different regions of the ducto-lobular tree. Currently, our biopsy tools are rudimentary, but as these improve, the ability to genetically map the sequence of events during carcinogenesis up and down the ductal tree offers perhaps one of the most exciting avenues for increasing understanding or breast cancer carcinogenesis.