Skip to main content

Advertisement

SpringerLink
Log in

Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Purpose

In order to evaluate the diagnostic and therapeutic potential of mammary ductoscopy and watchful follow-up for treating bloody nipple discharge, we investigated the incidence of cancer evolving from the location related to the affected duct and the disappearance of nipple discharge.

Patients and methods

Between April 1998 and March 2008, we assessed 709 lesions among 624 patients without a diagnosis of malignancy at the time of 6 months after mammary ductoscopy. The median follow-up time was 5.5 years. We reviewed the subjects’ charts retrospectively and investigated the dates on which discharge-related cancer was diagnosed and the disappearance of discharge was noted after the initial examination with mammary ductoscopy.

Results

The incidence of cancer evolving from the location related to the pathological duct was 11 % (78/709). Nipple discharge disappeared in 480 (85.1 %) of the 564 followed up lesions, with the exception of 78 breast cancers and 67 resected benign lesions. The rate of disappearance for nipple discharge in the cases of intraductal papilloma at the first examination was 82.5 %. In cases in which no obvious lesions were observed on mammary ductoscopy, there was a 90 % probability that the nipple discharge would disappear, and the rate of evolving breast cancer in the cases of atypical papillary lesions at the first examination was significantly higher than that observed in the cases of intraductal papilloma, at 50 and 8.9 %, respectively.

Conclusions

Information revealed by mammary ductoscopy is useful for differentiating patients who should be subjected to intensive examinations and those who should expect disappearance of their discharge. Mammary ductoscopy and watchful follow-up can substitute microdochectomy in patients with bloody nipple discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cabioglu N, Hunt KK, Singletary SE, Stephens TW, Marcy S, Ross MI, et al. Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. J Am Coll Surg. 2003;196(3):354–64.

    Article  PubMed  Google Scholar 

  2. Dooley WC, Ljung B-M, Veronesi U, Cazzaniga M, Elledge RM, O’Shaughnessy JA, et al. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst. 2001;93(21):1624–32.

    Article  CAS  PubMed  Google Scholar 

  3. Wrensch MR, Petrakis NL, King EB, Miike R, Mason L, Chew KL, et al. Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid. Am J Epidemiol. 1992;135(2):130–41.

    CAS  PubMed  Google Scholar 

  4. Teboul M. A new concept inbreast investigation; echo-histological acino-ductal analytic echography. Biomed Pharmacother. 1988;42:289–96.

    CAS  PubMed  Google Scholar 

  5. Makita M, Sakamoto G, Akiyama F, Namba K, Sugano H, Kasumi F, et al. Duct endoscopy and endoscopic biopsy in the evaluation of nipple discharge. Breast Cancer Res Treat. 1991;18:179–88.

    Article  CAS  PubMed  Google Scholar 

  6. Tang SS, Twelves DJ, Isacke CM, Gui GP. Mammary ductoscopy in the current management of breast disease. Surg Endosc. 2011;25(6):1712–22.

    Article  PubMed  Google Scholar 

  7. Hunerbein M, Schwarz LE, Schneider U, Schlag PM. Evaluation of pathologic nipple discharge with ductoscopy. J Am Coll Surg. 2003;197:697–8.

    Article  PubMed  Google Scholar 

  8. Shen RW, Wu J, Lu JS, Han QX, Shen ZZ, Nguyen M, et al. Fiberoptic ductoscopy for patients with nipple discharge. Cancer. 2000;89(7):1512–9.

    Article  CAS  PubMed  Google Scholar 

  9. Dominguez-Cunchillos F, Armendariz P, Perez-Cabanas I, Artieda C, Oteiza F, Sanz MA. Endoscopic technique for the localization of intraduct papillomas. Brit J Surg. 1999;86:1470–1.

    Article  CAS  PubMed  Google Scholar 

  10. Pereira B, Mokbel K. Mammary ductoscopy: past, present, and future. Int J Clin Oncol. 2005;10:112–6.

    Article  PubMed  Google Scholar 

  11. Al Sarakbi W, Salhab M, Mokbel K. Does mammary ductoscopy have a role in clinical practice? Int Semin Surg Oncol. 2006;3:16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Dooley WC. Routine operative breast endoscopy during lumpedomy. Ann Surg Oncol. 2003;10:38–42.

    Article  PubMed  Google Scholar 

  13. Makita M, Namba K, Aoyama E, Mizutani M, Murata H, Yamao R, et al. Endoscopic diagnosis of intraductal lesions in patients with nipple discharge. Jpn J Breast Cancer. 1996;11(1):134–41 (in Japanese with English summary).

    Google Scholar 

  14. Dillon MF, Mohd Nazri SR, Nasir S, Mc Dermott EW, Evoy D, Crotty TB, et al. The role of major duct excision and microdochectomy in the detection of breast carcinoma. BMC Cancer. 2006;6:164. doi:10.1186/1471-2407-6-164.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kamali S, Bender O, Kamali GH, Aydin MT. Karatepe, and Yuney E:Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer. 2014;21(2):154–61.

    Article  PubMed  Google Scholar 

  16. Makita M, Akiyama F, Gomi N, Ikenaga M, Yoshimoto M, Kasumi F, et al. Endoscopic classification of intraductal lesions and histological diagnosis. Breast Cancer. 2002;9(3):220–5.

    Article  PubMed  Google Scholar 

  17. Ashfaq A, Senior D, Pockaj BA, Wasif N, Pizzitola VJ, Giurescu ME, et al. Validation study of a modern treatment algorithm for nipple discharge. Am J Surg. 2014. doi:10.1016/j.amjsurg.2013.12.035.

    PubMed  Google Scholar 

  18. Matsunaga T, Kawakami Y, Namba K, et al. Intraductal biopsy for diagnosis and treatment of intraductal lesions of the breast. Cancer. 2004;101(10):2164–9.

    Article  PubMed  Google Scholar 

  19. Nelson RS, Hoehn JL. Twenty-year outcome following central duct resection for bloody nipple discharge. Ann Surg. 2006;243(4):522–4.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312(3):146–51.

    Article  CAS  PubMed  Google Scholar 

  21. Haagensen CD (1986) Solitary intraductal papilloma, multiple intraductal papilloma. Disease of the breast, 3rd edn. Philadelphia: W.B. Saunders Co.; 1986. p. 136–191.

  22. Ali-Fehmi R, Carolin K, Wallis T, Visscher DW. Clinicopathologic analysis of breast lesions associated with multiple papillomas. Hum Pathol. 2003;34:234–9.

    Article  CAS  PubMed  Google Scholar 

  23. Makita M, Akiyama F, Gomi N, Iwase T, Kasumi F, Sakamoto G. Endoscopic and histological findings of intraductal lesions presenting with nipple discharge. Breast J. 2006;12(s2):s210–7.

    Article  PubMed  Google Scholar 

  24. Makita M, Akiyama F, Kimura K, et al. Mammary ductoscopic diagnosis of intraductal spread of breast cancer. Jpn J Breast Cancer. 2001;16(3):274–8 (in Japanese with English summary).

    Google Scholar 

  25. Simpson JS, Connolly EM, Leong WL, Escallon J, McCready D, Reedijk M, et al. Mammary ductoscopy in the evaluation and treatment of pathologic nipple discharge: a Canadian experience. Can J Surg. 2009;52(6):E245–8.

    PubMed  PubMed Central  Google Scholar 

  26. Ballesio L, Maggi C, Savelli S, Angeletti M, De Felice C, Meggiorini ML, et al. Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study. Radiol Med. 2008;113(2):249–64.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a Grant from Foundation for Promotion of Cancer Research.

Conflict of interest

No authors have any conflict of interest to declare in association with this study.

Author information

Authors and Affiliations

  1. Department of Breast Surgical Oncology, Breast Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Masujiro Makita & Takuji Iwase

  2. Department of Pathology, Cancer Institute, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Futoshi Akiyama

  3. Department of Diagnostic Radiology, Breast Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Naoya Gomi

Authors
  1. Masujiro Makita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Futoshi Akiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naoya Gomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takuji Iwase
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masujiro Makita.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Makita, M., Akiyama, F., Gomi, N. et al. Mammary ductoscopy and watchful follow-up substitute microdochectomy in patients with bloody nipple discharge. Breast Cancer 23, 242–251 (2016). https://doi.org/10.1007/s12282-014-0561-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-014-0561-z

Keywords

Search

Navigation