Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests.

BACKGROUND: This study aims to assess the role of ductoscopy for detecting intraductal anomalies in patients with nipple discharge in comparison to conventional tests and to find an effective combination of both approaches. MATERIALS AND METHODS: Prior to duct excision, ductoscopy was performed in 97 women. Histologic and all other diagnostic results were compared. Sensitivity, specificity, and efficiency were calculated for all methods. These parameters were also calculated for all possible test combinations in 12 patients who had completed all tests. RESULTS: Breast sonography reached the highest sensitivity (64.1%) and efficiency (64%); mammography had the highest specificity (100%). The sensitivity of ductoscopy was 53.2%, its specificity 60%, and its efficiency 55.1%. Among combinations of all methods, the combination ductoscopy + galactography was the most sensitive (80%). Mammography, magnetic resonance imaging, and ductoscopy were each 100% specific. Ductoscopy was the most efficient (75%) single method. CONCLUSION: Ductoscopy is a valuable test for diagnosing intraductal lesions in patients with nipple discharge. It is more efficient than conventional tests in patients undergoing all tests.

Polypropylene mesh implantation in combination with vacuum-assisted closure in the management of metastatic or locally recurrent vulvar cancer: case report and review of literature.

BACKGROUND: Mesh reconstruction, especially in combination with vacuum-assisted closure, might improve healing and reduce the surgical morbidity of extensive inguinofemoral lymphadenectomy or extensive local resection in progressive cancer of the vulva. CASES: Radical vulvectomy combined with inguinofemoral lymphadenectomy was performed in 2 patients (P1, P2). The inguinofemoral wound bed was stabilized by polypropylene mesh implantation and sealed with vacuum closure system. In 1 patient with local recurrence of vulvar cancer (P3), local excision and stabilization of the wound were performed by mesh implantation. CONCLUSIONS: Mesh implantation fulfills 2 purposes: (1) it protects exposed vessels and the wound can be vacuum sealed; and (2) it stabilizes the surgical bed, permitting the required radical excision locally and inside the vascular compartment.

Can an instruction video or palpation aid improve the effectiveness of breast self-examination in detecting tumors? An experimental study.

INTRODUCTION: Although large randomized trials have not shown benefits for breast self-examination (BSE), many organizations still endorse the practice. This study aimed to determine whether an instruction video or palpation aid improved the effectiveness of BSE. METHODS: A total of 100 volunteers (50 men and 50 women) with no previous experience of BSE and/or clinical breast palpation were randomly assigned to the following intervention: instruction video seen versus not seen and use of palpation aids versus aids not used. Participants completed psychological trait and previous knowledge questionnaires before the intervention and/or breast examination. Examination was carried out on 24 different sized silicone breast forms, into 20 of which had been inserted tumor equivalents measuring 0.8-3.0 cm in diameter. The dependent variable was the rate of accurate tumor detection--the mean sum of correct positive hits (CPH)--defined as tumors detected within 20 s. Mean CPH values were then analyzed in relation to the interventions and other variables including gender and psychological measures (ANOVA and COVAR). RESULTS: Neither the instruction video nor interaction effects between gender and the instruction video influenced the mean CPH value. Furthermore, the palpation aid was strongly and significantly associated with a reduced detection (p=0.00003). CONCLUSION: Using an instruction video or palpation aid did not improve the effectiveness of breast examination in detecting tumors--a finding which supports results from large randomized studies. It is difficult to understand why BSE is still promoted by various groups.