ABSTRACT
INTRODUCTION: Total duct excision (TDE) is performed for the diagnosis and management of nipple discharge. The Association of Breast Surgery's recent guidelines recommend considering diagnostic surgery for single-duct, blood-stained or clear nipple discharge, and for symptomatic management. METHODS: We retrospectively reviewed the diagnostic and surgical outcomes of all cases of TDE between January 2013 and November 2019. RESULTS: In total, 259 TDEs were carried out: 219 for nipple discharge, 29 for recurrent mastitis, 3 for screening abnormalities and 8 for breast lumps. Of the nipple discharge group, 121 had blood-stained discharge. Mean patient age was 52 years (range 19-81). Median follow-up time was 45 months (interquartile range 24-63). The following cases were identified on histopathology: 236 benign breast changes, 10 atypical ductal hyperplasia, 4 lobular carcinoma in situ, 2 low-grade ductal carcinoma in situ (DCIS), 3 intermediate-grade DCIS, 2 high-grade DCIS and 2 invasive ductal carcinomas. In total, 3.5% of patients who underwent TDE had a diagnosis of DCIS or invasive carcinoma. Blood-stained discharge was associated with a significant increase in risk of DCIS or carcinoma compared with other nipple discharge colours (p = 0.043). The most common complications of TDE were infection, poor wound healing and haematoma. Nipple discharge recurred in 14.2% of cases. CONCLUSIONS: TDE can be considered for the diagnostics and management of nipple discharge. Blood-stained nipple discharge increases the risk of DCIS or malignancy, but the majority of the time TDE reveals benign breast pathology.
Subject(s)
Breast Neoplasms , Nipple Discharge , Humans , Female , Middle Aged , Adult , Retrospective Studies , Aged , Aged, 80 and over , Breast Neoplasms/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Young Adult , Nipples/surgery , Nipples/pathology , Treatment Outcome , Carcinoma, Intraductal, Noninfiltrating/surgery , Carcinoma, Intraductal, Noninfiltrating/diagnosis , Carcinoma, Intraductal, Noninfiltrating/pathology , Mammary Glands, Human/surgery , Mammary Glands, Human/pathologySubject(s)
Breast Diseases/diagnostic imaging , Sutures , Equipment Design , Humans , Radiography , Specimen HandlingABSTRACT
This paper presents a novel interactive reality video playback approach developed for biomedical training purposes, and tested on a prototype breast self-examination (BSE) multimedia training application. The system is developed in order to improve on existing video playback approaches as used in multimedia applications by providing control over not only time, as in conventional video playback, but also space. The benefits of interactive reality video playback are presented and the approach is compared with other similar approaches, such as QuickTime and iPIX. The design, development, final implementation, testing and evaluation plan of the IRiS system are presented. The paper also discusses future plans and the use of the system in other biomedical training scenarios.
