Advertisement

Breast Cancer Research and Treatment

, Volume 99, Issue 3, pp 301–307 | Cite as

Ductoscopy and intraductal vacuum assisted biopsy in women with pathologic nipple discharge

  • Michael HünerbeinEmail author
  • Matthias Raubach
  • Bernhard Gebauer
  • Wolfgang Schneider
  • Peter M. Schlag
Clinical trial

Abstract

Background

Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors.

Methods

From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen

Results

Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ.

Conclusions

Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.

Keywords

Breast cancer Ductoscopy Intraductal biopsy Intraductal disease 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Frykberg ER, Masood S, Copeland EM, Bland K (1993) Ductal carcinomka in situ of the breast. Surg Gyn Obstet 177:425–440Google Scholar
  2. 2.
    Hou MF, Huang TJ, Liu GC (2005) The diagnostic value of galactography in patients with nipple discharge. Clin Imaging 25:74–81Google Scholar
  3. 3.
    Cabioglu N, Hunt KK, Singletary SE, Stephens TW, Marcy S, Meric F, Ross MI, Babiera GV, Ames FC, Kuerer HM (2003) Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. J Am Coll Surg 196:354–364PubMedCrossRefGoogle Scholar
  4. 4.
    King TA, Carter KM, Bolton JS, Fuhrman GM (2000) A simple approach to nipple discharge. Am Surg 66:960–965PubMedGoogle Scholar
  5. 5.
    Irfan K, Brem RF (2002) Surgical and mammographic follow up of papillary lesions and atypiacal lobular hyperplasia diagnosed with stereotactic vacuum assisted biopsy. Breast J 8:230–233PubMedCrossRefGoogle Scholar
  6. 6.
    Love SM, Barsky SH (1996) Breast-duct endoscopy to study stages of cancerous breast disease. Lancet 348:997–999PubMedCrossRefGoogle Scholar
  7. 7.
    Okazaki A, Okazaki M, Asaishi K, Satoh H, Watanabe Y, Mikami T, Toda K, Okazaki Y, Nabeta K, Hirata K et’al. (1991) Fiberoptic ductoscopy of the breast: a new diagnostic procedure for nipple discharge Jpn J Clin Oncol 21:188–193PubMedGoogle Scholar
  8. 8.
    Shen KW, Wu J, Lu JS, Han QX, Shen ZZ, Nguyen M, Shao ZM, Barsky SH (2000) Fiberoptic ductoscopy for patients with nipple discharge. Cancer 89:1512–1519PubMedCrossRefGoogle Scholar
  9. 9.
    Dooley WC, Francescatti D, Clark L, Webber G (2004) Office-based breast ductoscopy for diagnosis. Am J Surg 188:415–418PubMedCrossRefGoogle Scholar
  10. 10.
    Hünerbein M, Estevez-Schwarz L, Schneider U, Schlag PM (2003) Evaluation of pathologic nipple discharge with ductoscopy. J Am Coll Surg 197:697–698PubMedCrossRefGoogle Scholar
  11. 11.
    Shen KW, Wu J, Lu JS, Han QX, Shen ZZ, Nguyen M, Barsky SH, Shao ZM (2001) Fiberoptic ductoscopy for breast cancer patients with nipple discharge. Surg Endosc 15:1340–1345PubMedCrossRefGoogle Scholar
  12. 12.
    Dawes LG, Bowen C, Venta LA, Morrow M (1998) Ductography for nipple discharge: no replacement for ductal excision. Surgery 124:685–691PubMedCrossRefGoogle Scholar
  13. 13.
    Matsunaga T, Ohta D, Misaka T, Hosokawa K, Fujii M, Kaise H, Kusama M, Koyanagi Y (2001) Mammary ductoscopy for diagnosis and treatment of intraductal lesions of the breast. Breast Cancer 8:213–221PubMedCrossRefGoogle Scholar
  14. 14.
    Yamamoto D, Shoji T, Kawanishi H, Nakagawa H, Haijima H, Gondo H, Tanaka K (2001) A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge. Breast Cancer Res Treat 70:103–108PubMedCrossRefGoogle Scholar
  15. 15.
    Dietz JR, Crowe JP, Grundfest S, Arrigain S, Kim JA (2002) Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery 132:582–587PubMedCrossRefGoogle Scholar
  16. 16.
    Moncrief RM, Nayar R, Diaz LK, Staradub VL, Morrow M, Khan SA (2005) A comparison of ductoscopy-guided and conventional surgical excision in women with spontaneous nipple discharge. Ann Surg 241:575–581PubMedCrossRefGoogle Scholar
  17. 17.
    Sharma P, Klemp JR, Simonson M, Welsko CM, Zalles CM, Kimler BF, Fabian CJ (2004) Failure of high risk women to produce nipple aspirate fluid does not exclude detection of cytologis atypia in random periareolar fine needle aspiration specimens. Breast Cancer Res Treat 87:64CrossRefGoogle Scholar
  18. 18.
    Wrensch MR, Petrakis NL, Miike R, King EB, Chew K, Neuhaus J, Lee MM, Rhys M (2001) Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid. J Natl Cancer Inst 93:1791–1798PubMedCrossRefGoogle Scholar
  19. 19.
    Wrensch M, Petrakis NL, King EB, Lee MM, Miike R (1993) Breast cancer risk associated with abnormal cytology in nipple aspirates of breast fluid and prior history of breast biopsy. Am J Epidemiol 137:829–833PubMedGoogle Scholar
  20. 20.
    Dooley WC, Ljung BM, Veronesi U, Cazzaniga M, Elledge RM, O'Shaughnessy JA, Kuerer HM, Hung DT, Khan SA, Phillips RF, Ganz PA, Euhus DM, Esserman LJ, Haffty BG, King BL, Kelley MC, Anderson MM, Schmit PJ, Clark RR, Kass FC, Anderson BO, Troyan SL, Arias RD, Quiring JN, Love SM, Page DL, King EB (2001) Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst 93:1624–1632PubMedGoogle Scholar
  21. 21.
    Khan SA, Wiley EL, Rodriguez N, Baird C, Ramakrishnan R, Nayar R, Bryk M, Bethke KB, Staradub VL, Wolfman J, Rademaker A, Ljung BM, Morrow M (2004) Ductal lavage findings in women with known breast cancer undergoing mastectomy. J Natl Cancer Inst 96:1510–1517PubMedGoogle Scholar
  22. 22.
    Sauter ER, Ehya H, Schlatter L, MacGibbon B (2004) Ductoscopic cytology to detect breast cancer. Cancer J 10:33–41PubMedCrossRefGoogle Scholar
  23. 23.
    Fabian CJ, Kimler BF, Mayo MS (2004) Ductal lavage for early detection—what doesn´t come out in the wash. J Nat Cancer Inst 96:1488–1489PubMedCrossRefGoogle Scholar
  24. 24.
    Hünerbein M: Optical biopsy instrument. German Patent No. 10258483, US Patent application No. WO 2004/052210 A1, 2004Google Scholar
  25. 25.
    Dooley WC (2002) Routine operative breast endoscopy for bloody nipple discharge. Ann Surg Oncol 9:920–923PubMedCrossRefGoogle Scholar
  26. 26.
    Kim JA, Crowe JP, Woletz J, Dinunzio A, Kelly T, Dietz JR (2004) Prospective study of intraoperative mammary ductoscopy in patients undergoing partial mastectomy for breast cancer. Am J Surg 188:411–414PubMedCrossRefGoogle Scholar
  27. 27.
    Matsunaga T, Kawakami Y, Namba K, Fujii M (2004) Intraductal biopsy for diagnosis and treatment of intraductal lesions of the breast. Cancer 101:2164–2169PubMedCrossRefGoogle Scholar
  28. 28.
    Page DL, Salhany KE, Jensen RA, Dupont WD (1996) Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer 78:258–266PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Michael Hünerbein
    • 1
    • 4
    Email author
  • Matthias Raubach
    • 1
  • Bernhard Gebauer
    • 3
  • Wolfgang Schneider
    • 2
  • Peter M. Schlag
    • 1
  1. 1.Department of Surgery and Surgical OncologyCharité Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of PathologyCharité Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of RadiologyCharité Universitätsmedizin BerlinBerlinGermany
  4. 4.Department of Surgery and Surgical OncologyBerlinGermany

Personalised recommendations