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Evaluation of pain experienced during breast ductal endoscopy

Surgery Today volume 38, pages 886–889 (2008)Cite this article

Abstract

Purpose

Ductal endoscopy is valuable for the differential diagnosis of bloody nipple discharge; however, the pain associated with this procedure has not been evaluated. This study aims to assess the pain experienced by patients during ductal endoscopy.

Methods

We studied a consecutive series of women who underwent ductal endoscopy, to investigate the cause of bloody nipple discharge. The procedure was performed using standard local anesthesia (lidocaine 1% 10 ml without epinephrine, involving nipple block and periaureolar administration). Patients were asked to score the level of pain with a visual analog scale, 1, 4, 7, 12, 17, 22, 27, and 32 min after the procedure, and describe their overall and maximum pain.

Results

This series comprised 20 women aged from 27 to 68 years old. The overall pain (mean ± SE) score was equal to 5.8 ±0.3, and the maximum pain score was 8.3 ± 0.2. The peak of pain corresponded with when the dilator was inserted through the sphincter. The group in which the dilator was inserted after 4 min experienced more intense maximum and overall pain after 7, 12, 17 and 22 min.

Conclusions

Pain is an important factor in ductal endoscopy, and peaks relatively early. A standard, baseline local lidocaine dose of greater than 10 ml may be necessary at the beginning of the procedure. Late insertion of the dilator seems to be an indicator of the force of the procedure.

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References

  1. King TA, Carter KM, Bolton JS, Fuhrman GM. A simple approach to nipple discharge. Am Surg 2000;66:960–965; discussion 965-6.

    PubMed  CAS  Google Scholar 

  2. Kijima Y, Owaki T, Yoshinaka H, Aikou T. Synchronous bilateral breast cancer with Paget’s disease and invasive ductal carcinoma: report of a case. Surg Today 2003;33:606–608.

    PubMed  Article  Google Scholar 

  3. Izumi J, Komaki K, Hirokawa M, Masuda E, Monden Y. Secretory carcinoma of the breast with a cystically dilated intraductal component: report of a case. Surg Today 2003;33:110–113.

    PubMed  Article  Google Scholar 

  4. Tumyan L, Basset LW. The clinically abnormal breast. In: Bassett LW, Jackson VP, Fu KL, editors. Diagnosis of diseases of the Breast. 2nd ed. Philadelphia: Elsevier; 2005. p. 519–529.

    Google Scholar 

  5. Louie LD, Crowe JP, Dawson AE, Lee KB, Baynes DL, Dowdy T, et al. Identification of breast cancer in patients with pathologic nipple discharge: does ductoscopy predict malignancy? Am J Surg 2006;192:530–533.

    PubMed  Article  Google Scholar 

  6. Florio MG, Manganaro T, Pollicino A, Scarfo P, Micali B. Surgical approach to nipple discharge: a ten-year experience. J Surg Oncol 1999;71:235–238.

    Article  Google Scholar 

  7. Khan SA, Wiley EL, Rodriguez N, Baird C, Ramakrishnan R, Nayar R, et al. Ductal lavage findings in women with known breast cancer undergoing mastectomy. J Natl Cancer Inst 2004;96:1510–1517.

    PubMed  Article  Google Scholar 

  8. Dooley WC, Francescatti D, Clark L, Webber G. Office-based breast ductoscopy for diagnosis. Am J Surg 2004;188:415–418.

    PubMed  Article  Google Scholar 

  9. Yamamoto D, Shoji T, Kawanishi H, Nakagawa H, Haijima H, Gondo H, et al. A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge. Breast Cancer Res Treat 2001;70:103–108.

    PubMed  Article  CAS  Google Scholar 

  10. Hunerbein M, Estevez Schwarz L, Schneider U, Schlag PM. Evaluation of pathologic nipple discharge with ductoscopy. J Am Coll Surg 2003;197:697–698.

    PubMed  Article  Google Scholar 

  11. Pereira B, Mokbel K. Mammary ductoscopy: past, present, and future. Int J Clin Oncol 2005;10:112–116.

    PubMed  Article  Google Scholar 

  12. Dietz JR, Crowe JP, Grundfest S, Arrigain S, Kim JA. Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery 2002;132:582–587; discussion 587–8.

    PubMed  Article  Google Scholar 

  13. Grunwald S, Bojahr B, Schwesinger G, Schimming A, Kohler G, Schulz K, et al. Mammary ductoscopy for the evaluation of nipple discharge and comparison with standard diagnostic techniques. J Minim Invasive Gynecol 2006;13:418–423.

    PubMed  Article  Google Scholar 

  14. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.

    PubMed  Article  CAS  Google Scholar 

  15. Spitzer RL, Endicott J. Schedule for affective disorders and schizophrenia — lifetime version, 3rd ed. New York: New York State Psychiatric Institute; 1979.

    Google Scholar 

  16. Danforth DN Jr, Abati A, Filie A, Prindiville SA, Palmieri D, Simon R, et al. Combined breast ductal lavage and ductal endoscopy for the evaluation of the high-risk breast: a feasibility study. J Surg Oncol 2006;94:555–564.

    PubMed  Article  Google Scholar 

  17. Fralinger JA, Kurtzman SH. Combined ductal lavage and ductoscopy: what is the future for the intraductal approach? J Surg Oncol 2006;94:553–554.

    PubMed  Article  Google Scholar 

  18. Lifeline Biotechnologies, Inc. Demo CD-ROM for MastascopeTM. Reno, NV: Lifeline Biotechnologies; 2005.

    Google Scholar 

  19. Locke I, Mitchell G, Eeles R. Ductal approaches to assessment and management of women at high risk for developing breast cancer. Breast Cancer Res 2004;6:75–81.

    PubMed  Article  Google Scholar 

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Affiliations

  1. Breast Unit, First Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece

    George C. Zografos, Flora Zagouri, Theodoros N. Sergentanis, Nikolaos Pararas, Vassiliki Oikonomou, Effrosyni Panopoulou, Constantine Fotiadis & John Bramis

  2. Research Center, Hellenic Anticancer Institute, Athens, Greece

    Antonia Gounaris

Authors
  1. George C. Zografos
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  2. Flora Zagouri
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  3. Theodoros N. Sergentanis
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  4. Antonia Gounaris
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  5. Nikolaos Pararas
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  6. Vassiliki Oikonomou
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  7. Effrosyni Panopoulou
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  8. Constantine Fotiadis
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  9. John Bramis
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Zografos, G.C., Zagouri, F., Sergentanis, T.N. et al. Evaluation of pain experienced during breast ductal endoscopy. Surg Today 38, 886–889 (2008). https://doi.org/10.1007/s00595-007-3725-z

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  • DOI: https://doi.org/10.1007/s00595-007-3725-z

Key words

  • Visual analog scale
  • Ductoscopy
  • Nipple discharge
  • Pain
  • Lidocaine