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Office Ductoscopy for Surgical Selection in Women with Pathologic Nipple Discharge

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pathologic nipple discharge (PND) is diagnosed clinically and managed by diagnostic duct excision (DDE). Mammary ductoscopy in the office setting may change this standard. We performed a prospective study to assess the utility of office ductoscopy for surgical selection in women with nipple discharge.

Methods

Women with nipple discharge meeting at least 2 of 3 criteria of PND (spontaneous, single duct, bloody or serous) underwent office ductoscopy. Those showing papillomatous lesions underwent DDE in the operating room (surgical group, n = 38); if no lesion was present, women were followed clinically (observation group, n = 21).

Results

A papillomatous lesion was identified in 79% of women with 3-criteria PND and in 21% with 2 criteria (P = .001). DDE yielded a proliferative lesion in 35 of 38 women (92%). Of the 38, 27 (71%) had papillomata, 2 (5%) had florid hyperplasia, and 6 (16%) had ductal carcinoma in situ (DCIS) on final pathology. Also, 11 women with papilloma and 1 with DCIS presented with 2-criteria PND. Ductoscopy findings were a better predictor of the presence of intraductal neoplasia (area under curve [AUC] 0.9, 95% confidence interval [95% CI] 0.8–0.98) compared with 3-criteria PND (AUC 0.7, 95% CI 0.6–0.8). The 21 women in the observation group did not develop signs of malignancy or need biopsy during a 48-month follow-up period.

Conclusions

Our findings suggest that office ductoscopy provides accurate surgical selection of women with nipple discharge and should be considered for women with 2 criteria of PND, and those with negative ductoscopy can be safely observed. These findings need confirmation in a larger study with longer follow-up.

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Authors and Affiliations

  1. Department of Surgery, Lynn Sage Breast Center, Northwestern Feinberg School of Medicine, Chicago, IL, USA

    Seema A. Khan MD, Amrit Mangat MD & Elizabeth Revesz MD

  2. Beaumont Breast Center, Beaumont Hospital, Royal Oak, MI, USA

    Aeisha Rivers MD

  3. Pathology Laboratory, Abbott Northwestern Hospital, Minneapolis, MN, USA

    Barbara Susnik MD

  4. Robert H. Lurie Cancer Center, Northwestern Feinberg School of Medicine, Chicago, IL, USA

    Nora Hansen MD

Authors
  1. Seema A. Khan MD
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  2. Amrit Mangat MD
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  3. Aeisha Rivers MD
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  4. Elizabeth Revesz MD
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  5. Barbara Susnik MD
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  6. Nora Hansen MD
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Correspondence to Seema A. Khan MD.

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Khan, S.A., Mangat, A., Rivers, A. et al. Office Ductoscopy for Surgical Selection in Women with Pathologic Nipple Discharge. Ann Surg Oncol 18, 3785–3790 (2011). https://doi.org/10.1245/s10434-011-1791-3

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  • DOI: https://doi.org/10.1245/s10434-011-1791-3

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