A comparative analysis of diagnostic values of high-frequency ultrasound and fiberoptic ductoscopy for pathologic nipple discharge.

BACKGROUND: This study aimed to compare the diagnostic accuracy of high-frequency ultrasound (HFUS) and fiberoptic ductoscopy (FDS) for pathologic nipple discharge (PND). METHODS: HFUS and FDS were conducted in 210 patients with PND (248 lesions) treated at our hospital. The diagnostic accuracy of these two methods was compared using pathological diagnosis as the standard. RESULTS: Among 248 lesions, 16 and 15 of 16 malignant lesions were accurately diagnosed by HFUS and FDS, respectively. Of 232 benign lesions, 183 and 196 cases were accurately diagnosed by HFUS and FDS, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HFUS in diagnosis of intraductal lesions were 84.36% (95% CI 79.26-88.39%), 60% (95% CI 23.07-92.89%), 96.03% (95% CI 96.55-99.83%), and 7.31% (95% CI 2.52-19.4%) respectively. The sensitivity, specificity, PPV, and NPV of FDS in diagnosis of intraductal lesions were 86.83% (95% CI 82.00-90.52%), 100% (95% CI 56.55-100%), 100% (95% CI 98.21-100%), and 13.51% (95% CI 5.91-27.98%) respectively. Diagnostic accuracy rates of HFUS and FDS were 83.87% (208/248) and 85.08% (211/248), respectively, exhibiting no statistically differences (χ2 = 0.80, P > 0.05). The accuracy of HFUS combined with FDS was 93.14% (231/248), showing statistically differences (χ2 = 10.91, P < 0.05). CONCLUSIONS: Both HFUS and FDS demonstrated high diagnostic values for PND. HFUS has the advantage of non-invasive for nipple discharge with duct ectasia, exhibited good qualitative and localization diagnostic values. It is the preferred evaluation method for patients with nipple discharge. When HFUS cannot identify the cause of PND, FDS can be considered.

The diagnostic value of fiberoptic ductoscopy of the breast as an examination tool for pathological nipple discharge / 中华内分泌外科杂志

Objective To investigate the diagnostic value of fiberoptic ductoscopy (FDS) in pathological milky white nipple discharge.Methods The data of 1688 patients with pathological milky white nipple discharge who underwent FDS examination in Chengdu Third People's Hospital from Oct.2011 to Oct.2016 were analyzed retrospectively.Results Among the 1688 cases,the proportion of patients with milky white nipple discharge was 30％,higher than that of the bloody discharge (15％) and yellow liquid (24.5％).The detection rate of lesions in patients with milk nipple discharge was 9.3％,among whom 6.1％ was breast cancer.Conclusions FDS should be routinely performed in patients with pathological milky white nipple discharge,as an examination tool to exclude the intra ductal lesion.The disease should be paid more attention by physicians.

Application of Localization and Needle Placement Guided by Mammographic, Ultrasound and Fiberoptic Ductoscopy for Resection of Non-palpable Breast Lesions.

AIM: To evaluate the usefulness of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for non-palpable breast lesions. PATIENTS AND METHODS: Eighty-three patients undergoing needle localization and biopsy of non-palpable breast lesions under mammographic, ultrasound or fiberoptic ductoscopy guidance from June 2013 to December 2014 in Beijing Friendship Hospital were included in the study. The preoperative imaging assessment, application of localization needles, surgical operation and pathological examination were recorded and analyzed retrospectively. RESULTS: A total of 83 localization and biopsies were carried out, of which 27 were performed under mammographic guidance, 32 under ultrasound guidance and 24 under fiberoptic ductoscopy guidance. Twenty-seven cases of breast microcalcifications were localized under mammographic guidance and surgically removed, of which eight cases were pathologically diagnosed as malignant. Thirty-two cases of non-palpable breast lesions were localized under ultrasound guidance and 30 pathologically diagnosed, of these, four cases were pathologically diagnosed as malignant. Twenty-four cases of intraductal space-occupying lesions were localized under ductoscopy guidance and surgically removed, of which five cases were pathologically diagnosed as malignant. CONCLUSION: Utilization of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for non-palpable breast lesions is a safe and effective procedure, and is helpful in the diagnosis of breast cancer. With the help of this procedure, more malignant lesions can be localized and surgically removed.

Clinical Experience With Mammary Ductoscopy.

BACKGROUND: Most breast cancers begin in the ductal epithelium with normal cells and progress to atypia and finally to carcinoma. Mammary ductoscopy enables one to directly visualize and sample the ductal epithelium and, therefore, identify early changes cytologically. This article describes our initial experience with mammary ductoscopy at Beth Israel Medical Center. METHODS: A prospective review of all patients who underwent ductoscopy at Beth Israel Medical Center from November 2001 to February 2004 was performed. The indications for ductoscopy were a persistent nipple discharge, high-risk status, or intraoperative margin assessment in patients undergoing lumpectomy. RESULTS: Seventy-four patients underwent ductoscopic evaluation of 88 ducts. Of the 32 patients who underwent office ductoscopy, 15 were high risk, and 17 had spontaneous nipple discharge. Spontaneous nipple discharge was the indication for ductoscopy in 40 of 42 intraoperative procedures. The remaining two patients underwent ductoscopy for margin assessment during breast conservation, and final pathologic analysis revealed negative margins. Thirty-eight of the 40 patients who had spontaneous nipple discharge had abnormal findings during ductoscopy and therefore underwent ductoscopically guided duct excision. Carcinoma was the final diagnosis in 5 (8.8%) of the 57 patients who were scoped for nipple discharge. CONCLUSIONS: Mammary ductoscopy is a potentially useful tool in the evaluation of patients with spontaneous nipple discharge. This is a well-tolerated office procedure with minimal risks and complications. Mammary ductoscopy may have a role in the assessment of high-risk women. Further research is necessary to confirm these potential applications.

The significance of ductoscopy of mammary ducts in the diagnostics of breast neoplasms.

INTRODUCTION: Ductoscopy is a low invasive method enabling the diagnostics of intraductal proliferative lesions in breasts. Fiberoptic ductoscopy (FDS) is important in the diagnosis of patients with pathological nipple discharge. There are attempts to apply FDS in patients with breast cancer without the presence of nipple discharge. AIM: To assess fiberoptic ductoscopy in the diagnostics of breast neoplasms. MATERIAL AND METHODS: The material was composed of a group of 164 patients treated for intraductal proliferative lesions in breasts. In the analyzed group of patients, FDS was conducted in 128 patients with pathological nipple discharge and 36 patients with the presence of breast cancer. The analyzed period was divided into three sub-periods. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FDS examination verified by post-operative histopathological examination were analyzed. The safety of the method was also assessed, taking into consideration the complications. RESULTS: An increasing number of successful ductoscopies together with the number of performed FDS examinations was noted. There were statistically significant differences in the percentage of successful cannulations in relation to the number of performed FDS examinations in the three subsequent stages of the project (p = 0.011). The duration of FDS examination in the third period was reduced in comparison with the first and second period (p < 0.001). Sensitivity of fiberoptic ductoscopy is 68.1%, specificity 77.3% and PPV 90.4%, but NPV is 44.1%. CONCLUSIONS: The introduction of fiberoptic ductoscopy in our clinic has contributed to the widening of the diagnostic possibilities of small intraductal lesions of the mammary gland.

Clinical experience on breast fiberoptic ductoscopy from 1 368 re-ported cases of patients with breast intraductal lesion / 中国肿瘤临床

Objective:To consolidate ten years of clinical experience on the application of breast fiberoptic ductoscopy (FDS) in breast intra-ductal lesion. Methods:The clinical data of 1 368 cases of patients with nipple discharge were retrospectively collected and analyzed. Results:Significant differences were observed in the FDS diagnoses of patients with nipple discharge. The rates of tumor de-tection by FDS diagnosis were significantly higher when bloody and serous nipple discharge was used rather than milky and watery nip-ple discharge. For non-tumor nipple discharge, local drug perfusion via FDS was an effective treatment. A total of 303 patients had tu-mor resection or segmentectomy under localization via FDS, and 44 had segmentectomy after breast duct infusion of methylene blue. The diagnostic rate of localization via FDS (97.0%) was higher than that of breast duct infusion of methylene blue (86.4%). Conclu-sion:FDS is an accurate method for diagnosing patients with nipple discharge. In addition, it is also a good local drug perfusion method for patients with breast inflammatory nipple discharge ductoscopy. For patients with tumorous nipple discharge, localization via FDS can help improve the detection of the lesions, which can be removed by surgery.

Sonographic findings compared with fiberoptic ductoscopy in the patients of spontaneous nipple discharge / 中华超声影像学杂志

Objective To investigate the ultrasound diagnostic value for nipple discharge disease by comparison with fiberoptic ductoscopy. Methods Fiberoptic ductoscopy and ultrasonic inspection were performed on fifty-seven patients with spontaneous nipple discharge,and the results were analysed. Results In all patients, 55 cases (96. 49 % ) were abnormal in high-frequency ultrasound inspection:27 mammary duct expansion(47.36%),19 occupying lesion with mammary duct expansion or cyst (33.33%),6 cystic echo ( 10. 52% ) ,3 only solid echopattern (5.26%) ,and 2 nothing found (3.51% ). In ultrasonic inspection,color and pulse Doppler signal were found in 7 cases. On the other hand, 26 galactophoritis (45.61%), 12mammary duct ectasia (21.05 %), 17 intraductal papilloma (29.82%), 2 breast carcinoma (3.50%) were diagnosed by fiberoptic ductoscopy. In all 19 cases with occupying lesion,ultrasonography's sensitivity was 52. 63% ,specificity was 89. 47%, misdiagnosis rate was 10. 50%, rate of missed diagnosis was 47.36%.Conclusions To nipple discharge disease, high-frequency ultrasound has high sensitivity, easy to find abnormal indication,but is not accurate enough in the diagnosis of smaller occupying lesion.

Application of breast fiberoptic ductoscopy with abnormal nipple secretion(an analysis of 1000 cases) / 中国癌症杂志

Background and purpose:Nipple secretion is one of the frequent symptoms in mammary gland disease.Clinically,about 1% breast cancer patients demonstrate with nipple secretion as initial symptom.It could be used as a screening tool for the patients with nipple secretion but no palpated mass and increase the possibility of early diagnosis for breast cancer.In 1997,our country developed a new technique——breast fiberoptic ductoscopy(FDS). It uses a ?(0.7) millimeter optic scope to insert into the nipple discharge canal orifice,and depends on introscope technology to observe and record the normal or abnormal changes in mammary gland ductus.Its advantages are not only in highly diagnostic sensitivity(above 90%),but also in accurate location of tumor,so it can be used to diagnose early breast cancer and mammary gland ductal diseases.This study evaluated the clinical effect of breast FDS in diagnosis and treatment of abnormal nipple secretion.Methods:1 000 patients had been under examination by FDS.Results:Of the 1 000 cases,there were 33 cases((3.3%)) of early breast cancer;412 cases(41.2%) of papilloma and papillomatosis;and 480 cases(48%) of either ductal ectasia and or chronic inflammation.Duct endoscoptic biopsy was successfully performed on 30 cases,220 cases(55%) with chromic inflammation were cured by perfusion.453 cases were received operation.The accordance rate with pathologic eiagnosis was 90.7%.Conclusions:FDS is a very important and new method to diagnose breast.FDS could be inserted into 5th ducta lumen of breast and significantly increase the positive detection of breast cancer.Because the position and nature of the lesions can be determined accurately by FDS,tt is used as intervening treatment for some intraductal papilloma and chronic inflammatory disease.FDS will be of great influence on early diagnoses and treatment of the breast cancer.

Expressions of ER and PR in cast-off cells from fluid of latex ductal lavage and their significances in diagnosis and treatment of breast diseases / 吉林大学学报(医学版)

Objective To investigate the value of the expressions of estrogen receptor(ER)and progesterone receptor(PR)in the cast-off cells from the fluid of latex ductal lavage in the diagnosis and treatment of breast diseases.Methods A total of 58 female out-patients were examined by fiberoptic ductoscopy(FDS).All patients were divided into 6 groups by the complaints,physical examination,ultrasound and FDS:normal group(10 persons without symptoms and abnormalities in any examination),galactostasis group(n=19),latex fill up group(n=11),intraductal papilloma group(n=2),mammary ductal ectasia group(n=7)and contralateral examination after mastectomy for breast cancer group(n=9).A total of 168 ducts were successfully examined by FDS,and the expressions of ER and PR in the cast-off cells were detected among all of the samples.Results The positive rates of ER and PR expression in the cast-off cells from the fluid of latex ductal lavage in benign breast disease groups were much higher than those in normal group(P

Clinical application of ductoscopy: A report of 3 000 cases / 中国微创外科杂志

Objective To discuss the clinical value of f iberoptic ductoscopy in the diagnosis and treatment of breast diseases. Methods A total of 3 000 patients with mastalgia, breast mass or ni pple discharge received examinations by fiberoptic ductoscopy. Cytological exami nations were carried out in part of the patients after ductoscopy. Resu lts Of the 3 000 cases, there were 608 cases of intraductal space-occup ying lesions, 1 709 cases of obstructive galactophoritis, 350 cases of galactost asia, 24 cases of acute galactophoritis, 282 cases of simple mammarv duct ectasi a, and 27 cases of normal mammary ducts. Of 1 167 patients with nipple discharge , intraductal space-occupying lesions were clarified by ductoscopy in 585 cases (50%). Surgery was performed in 643 cases while intraductal interventional thera py was adopted in 2 365 cases. Conclusions Fiberoptic ductosco py may be used for the diagnosis and treatment of various breast diseases, not c onfined to nipple discharge.

Advances in Clinical Application of Fiberoptic Ductoscopy / 中国普外基础与临床杂志

Objective To introduce the current status of clinical application, value and perspective of fiberoptic ductoscopy.Methods The related literatures on advances in clinical application of fiberoptic ductoscopy were reviewed.Results Fiberoptic ductoscopy is now widely used in breast diseases, especially complicated with nipple discharge, and it has a higher accuracy rate than routine examinations. With ductoscopy, ductal lavage,location, biopsy and treatment can be carried out.Conclusion Fiberoptic ductoscopy has a greater value in diagnosis and treatment, we believe it will be better applied and further developed.

Fiberoptic ductoscopy in the diagnosis and treatment of nipple discharge / 医学研究生学报

Objective:Nipple discharge is a common complaint in women.There were no accurate techniques in detecting ductal lesions in nipple discharge patients before the application of fiberoptic ductoscopy.The aim of this study was to evaluate fiberoptic ductoscopy in the diagnosis and treatment of nipple discharge.Methods: From June 2007 to November 2008,a total of 95 patients with nipple discharge were submitted to fiberoptic ductoscopy,and 50 of them underwent surgery and pathological examination.Results: Of the 95 cases,2 diagnosed as breast cancer,58 intraductal papilloma,23 mammary duct ectasia,and 10 inflammatory disease of the mammary duct.Compared with the results of pathological examination,the accuracy of the fiberoptic ductoscopy was 81% for intraductal papilloma and 100% for breast carcinoma.Conclusions:Fiberoptic ductoscopy,as a convenient,safe and accurate method for the diagnosis and treatment of nipple discharge,can be used to confirm etiological factors and locate the site of the complaint.

Clinical application of fiberoptic ductoscopy in 800 cases / 中国微创外科杂志

Objective To assess the value of fiberoptic ductoscopy (FDS) in the diagnosis of nipple discharge.Methods Clinical records of 800 patients with nipple discharge undergoing FDS from October 1998 to July 2003 were retrospectively reviewed. Results Diagnoses established by FDS were pathologically confirmed in 92 2% of patients with papilloma (202/219), in 86 7% of patients with papillomatosis (13/15), and in 95 2% of patients with breast cancer (40/42). The total diagnostic accordance rate was 92 0% (266/289). Conclusions FDS in the diagnosis of nipple discharge is sensitive and of great clinical significance.

Subsequent treatment of nipple discharge after fiberoptic ductoscopic examination / 中国微创外科杂志

Objective To investigate subsequent treatment methods of nipple discharge after fiberoptic ductoscopic examination.Methods Intraductal lesions of 51 patients with nipple discharge were observed and assessed by fiberoptic ductoscopy.After examination,the patients were treated by various methods according to characteristic appearance of lesions under fiberoptic ductoscopy.The type of lesion with nipple discharge was classified as papillary lesions and nonpapillary lesions.And the papillary lesions could be further subdivided into nodular papillary lesions and irregular papillary lesions.There were 29 cases of nodular papillary lesion,23 of which were treated by local resection and 6 of which were given a simple mammectomy.There was 1 case of irregular papillary lesion,which was treated as malignant tumor after the focus was surgically removed and pathologically confirmed as breast cancer.Nonpapillary lesion was observed in 21 cases,18 of which were treated by local irrigation under ductoscopy,and 3 of which were treated as malignant tumor after the abnormal duct with its lobules was pathologically diagnosed as breast cancer.Results The 51 patients were followed with B-ultrasonography or chest roentgenography for 6～21 months(mean,14 months).No recurrence or metastasis was observed.Conclusions The characteristic appearance of lesion with nipple discharge under fiberoptic ductoscopy is an important evidence for choosing treatment method.

Treatment of exudative lesions in the mammary duct with fiberoptic ductoscopy / 中国微创外科杂志

Objective To discuss the efficacy of fiberoptic ductoscopy(FDS)in the treatment of mammary duct diseases with nipple discharge.Methods Fiberoptic ductoscopy was utilized for diagnosing and treating exudative lesions in the mammary duct in 72 cases(80 sides).After the lesion was detected under ductoscope,repeated irrigation using normal saline was performed until the flocculent discharge disappeared.Intraductal drug administration(dexamethasone 5 mg and gentamycin 40 000 U)was given during the retreat of ductoscope.Results There were 57 sides of galactophoritis and 23 sides of mammary duct ectasia.A complete recovery was achieved in 65 sides(nipple discharge disappeared completely and no relapse occurred in 6 months),in which a follow-up for 1～2 years showed no recurrence.A remarkable improvement was obtained in 15 sides(nipple discharge significantly reduced,or progressively decreased within 6 months,or underwear wetted occasionally).Conclusions Fiberoptic ductoscopy in the treatment of mammary duct lesions with abnormal nipple discharge is effective.

Differentiating diagnosis of no nipple discharge disease by fiberoptic ductoscopy / 中国普通外科杂志

Objective To study the characteristics of breast disease and the effect of differentating diagnosis of breast disease under fiberoptic ductoscopy(FDS). Methods 50 cases of breast disease were examined by FDS. Results There were hyperplasia of mammary glands in 31 cases; chronic mastitis in 5 cases; ductal ectasia in 7 cases and breast cancer in 7 cases by FDS in this series. The accord rate of pathological diagnosis with FDS was 98%,and with clinical diagnosis was 76%.Conclusions FDS is a very important and new method in the diagnosis of breast disease .FDS can detect early breast cancer. It can be used as intervening treatment for some intraductal papilloma and chronic inflammatory disesase.FDS has precis location and qualitation effect for diagnosis of breast disease. FDS will greatly influence the diagnosis and treatment of breast cancer.

Clinical application of fiberoptic ductoscopy in patients with nipple discharge / 中国普通外科杂志

Objective To assess the diagnostic value of fiberoptic ductoscopy(FDS) on the nipple discharge. Methods The clinical data of fifty two consecutive patients with nipple discharge undergoing FDS from November 1998 to April 1999 were retrospectively analysed. Results A total of 62 ducts in 52 patients were successfully examined by FDS. Intraductal tumor of the breast was found in 14 cases(4 cancer and 10 papilloma). The diagnostic rate of FDS on intraductal tumor was 100%; and 85.7% of these patients were microlesions. Six cases were diagnosed as mastitis. Thirty two normal duct cavities presented just simple dilatation. In 73.7% of non tumor patients, the nipple discharge disappeared after irregation via FDS. Conclusions As a simple technique and a minimal traumatic endoscopy, FDS would be useful in detection of the microlesions of breast and might become a new diagnostic method of nipple discharge instead of ductography.