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Mammary ductoscopy in the current management of breast disease

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Abstract

Background

The majority of benign and malignant lesions of the breast are thought to arise from the epithelium of the terminal duct-lobular unit (TDLU). Although modern mammography, ultrasound, and MRI have improved diagnosis, a final pathological diagnosis currently relies on percutaneous methods of sampling breast lesions. The advantage of mammary ductoscopy (MD) is that it is possible to gain direct access to the ductal system via the nipple. Direct visualization of the duct epithelium allows the operator to precisely locate intraductal lesions, enabling accurate tissue sampling and providing guidance to the surgeon during excision. The intraductal approach may also have a role in screening individuals who are at high risk of breast cancer. Finally, in spontaneous nipple discharge (SND), as biopsy instruments improve and intraductal therapeutics, such as intraductal excision and laser ablation, become a possibility, normal or benign ductoscopic findings may help minimize surgery in selected patients. As MD technology is rapidly advancing, a comprehensive review of current practice will be a valuable guide for clinicians involved in the management of breast disease.

Methods

This is a review of current ductoscopic practice based on an exhaustive literature search of Pubmed, Google Scholar, and conference proceedings. The search terms “ductoscopy”, “duct endoscopy”, “mammary”, “breast,” and “intraductal” were used.

Results/conclusions

Duct endoscopes have become smaller in diameter with working channels and improved optical definition. Currently, the role of MD is best defined in the management of SND facilitating targeted surgical excision, potentially avoiding unnecessary surgery, and limiting the extent of surgical resection for benign disease. The role of MD in breast-cancer screening and breast conservation surgery has yet to be fully defined. Few prospective randomized trials exist in the literature, and these would be crucial to validate current opinion, not only in the benign setting but also in breast oncologic surgery.

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Disclosures

Sarah S. K. Tang, Dominique J. Twelves, Clare M. Isacke, and Gerald P. H. Gui have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Academic Breast Unit, Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK

    Sarah S. K. Tang, Dominique J. Twelves & Gerald P. H. Gui

  2. Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK

    Clare M. Isacke

Authors
  1. Sarah S. K. Tang
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  2. Dominique J. Twelves
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  3. Clare M. Isacke
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  4. Gerald P. H. Gui
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Correspondence to Gerald P. H. Gui.

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Tang, S.S.K., Twelves, D.J., Isacke, C.M. et al. Mammary ductoscopy in the current management of breast disease. Surg Endosc 25, 1712–1722 (2011). https://doi.org/10.1007/s00464-010-1465-4

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  • DOI: https://doi.org/10.1007/s00464-010-1465-4

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