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Jiwa N, Kumar S, Gandhewar R, Chauhan H, Nagarajan V, Wright C, Hadjiminas D, Takats Z, Ashrafian H, Leff DR. Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature. Ann Surg Oncol 2021; 29:1774-1786. [PMID: 34839426 PMCID: PMC8627297 DOI: 10.1245/s10434-021-11070-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/28/2021] [Indexed: 01/07/2023]
Abstract
Background Nipple discharge is the third most frequent complaint of women attending rapid diagnostic breast clinics. Nipple smear cytology remains the single most used diagnostic method for investigating fluid content. This study aimed to conduct a systematic review and meta-analysis of the diagnostic accuracy of nipple discharge fluid assessment. Methods The study incorporated searches for studies interrogating the diagnostic data of nipple discharge fluid cytology compared with the histopathology gold standard. Data from studies published from 1956 to 2019 were analyzed. The analysis included 8648 cytology samples of women with a presenting complaint of nipple discharge. Both hierarchical and bivariate models for diagnostic meta-analysis were used to attain overall pooled sensitivity and specificity. Results Of 837 studies retrieved, 45 fulfilled the criteria for inclusion. The diagnostic accuracy of the meta-analysis examining nipple discharge fluid had a sensitivity of 75 % (95 % confidence interval [CI], 0.74–0.77) and a specificity of 87 % (95 % CI, 0.86–0.87) for benign breast disease. For breast cancer, it had a sensitivity of 62 % (95 % CI, 0.53–0.71) and a specificity 71 % (95 % CI, 0.57–0.81). Furthermore, patients presenting with blood-stained discharge yielded an overall malignancy rate of 58 % (95 % CI, 0.54–0.60) with a positive predictive value (PPV) of 27 % (95 % CI, 0.17–0.36). Conclusions Pooled data from studies encompassing nipple discharge fluid assessment suggest that nipple smear cytology is of limited diagnostic accuracy. The authors recommend that a tailored approach to diagnosis be required given the variable sensitivities of currently available tests. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11070-2.
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Affiliation(s)
- Natasha Jiwa
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
| | | | - Rishikesh Gandhewar
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Hemali Chauhan
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | | | - Corrina Wright
- Northwest London Pathology, Imperial College Healthcare Trust, London, UK
| | - Dimitri Hadjiminas
- Department of Breast Surgery, Imperial College Healthcare Trust, London, UK
| | - Zoltan Takats
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.,Department of Breast Surgery, Imperial College Healthcare Trust, London, UK
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Meta-analysis and cost-effectiveness of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge. Breast Cancer Res Treat 2021; 186:285-293. [PMID: 33475877 PMCID: PMC7990840 DOI: 10.1007/s10549-021-06094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/04/2021] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Pathological nipple discharge (PND) is a common breast-related complaint for referral to a surgical breast clinic because of its association with breast cancer. The aim of this meta-analysis was to compare the diagnostic efficacy of magnetic resonance imaging (MRI) and ductoscopy in patients with PND. Additionally, we determined the most cost-efficient strategy for the treatment of PND and the detection of breast cancer in PND patient without radiological suspicion for malignancy. MATERIALS AND METHODS PubMed and EMBASE were searched to collect the relevant literature from the inception of both diagnostic methods until January 27th 2020. The search yielded 815 original citations, of which 10 studies with 894 patients were finally included for analysis. Costs of ductoscopy, MRI and duct excision surgery were obtained from the UMC Utrecht as established in the year 2019. These costs included: medical personnel, overhead costs, material costs and sterilisation costs. RESULTS The meta-analysis showed no significant difference in sensitivity between ductoscopy (44%) and MRI (76%) for the detection of malignancy in patients with PND. However, ductoscopy (98%) had a statistically significantly higher specificity than MRI (84%). Individual costs were €1401.33, €822.13 and €6494.27 for ductoscopy, MRI and duct excision surgery, respectively. Full diagnostic strategy involving ductoscopy was on average €1670.97, while with MRI it was €2070.27. CONCLUSION Patients undergoing MRI are more often (false) positive which more often leads to duct excision surgery referrals compared to ductoscopy. This makes ductoscopy significantly more cost-effective compared MRI in patients with PND without radiological suspicion for malignancy.
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Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge. Breast Cancer 2020; 28:471-477. [PMID: 33180267 PMCID: PMC7925452 DOI: 10.1007/s12282-020-01184-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/02/2020] [Indexed: 01/20/2023]
Abstract
Background Pathologic nipple discharge (PND) is a common complaint often associated with breast cancer. However, when ultrasound and mammography are negative, the chances of malignancy are lower than 5%. Currently, major duct excision and microdochectomy are often recommended to alleviate symptoms and definitely rule out malignancy, but can cause infections and breastfeeding problems. Ductoscopy is a minimally invasive endoscopy technique that allows visualization of the mammary ducts and may not only obviate surgery but also detect malignancy. The aim of this study was to determine quality of life (QOL) after ductoscopy in patients with PND. Materials and methods All PND patients referred for ductoscopy between 2014 and 2015 to our hospital were included. Ductoscopy procedures were performed under local anaesthesia in the outpatient clinic. Patients were asked to fill out questionnaires (Breast-Q, EQ-5D-5L and SF-36) on the day of ductoscopy, and after 2 weeks, 3 and 6 months. Additionally, we performed reliability analysis to determine if these questionnaires were suitable for PND patients. Results Fifty consecutive patients underwent ductoscopy of whom 47 patients participated in this study. One domain of SF-36 (vitality) varied significantly over time. Breast-Q, SF-36 and EQ-5D-5L showed that QOL after ductoscopy for PND was unaffected by ductoscopy. Success of the ductoscopy procedure was a significant predictor for satisfaction with the result domain. Conclusion Ductoscopy is a minimally invasive technique that does not seem to impact QoL of PND patients over time. Breast-Q, SF-36 and EQ-5D-5L seem to be suitable existing QOL tests for PND patients undergoing ductoscopy, whereas SF-36 would require modifications.
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Wang B, Jiang S, Zhu L, Sheng W, Qiao Y, Zhang H, Zhang J, Liu Y, Hao N, Ma X, Zhou C, Ren Y. A Nomogram to Predict the Probability of Breast Intraductal Tumors in Patients with Nipple Discharge: A Real-World Study Based on Our 13-Year Clinical Experience. Cancer Manag Res 2020; 12:11191-11201. [PMID: 33177870 PMCID: PMC7650034 DOI: 10.2147/cmar.s273728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Nipple discharge is a common symptom of breast disease. We aimed to perform a descriptive statistical analysis of the cases we evaluated and establish a model to predict intraductal tumors. MATERIALS AND METHODS We conducted a retrospective study of patients from 2007 to 2019. In total, 1333 patients who completed the fiberoptic ductoscopy (FDS) were evaluated. The variables were analyzed by χ 2 test. Logistic regression was used to analyze the relationship between the patient's clinical characteristics and intraductal tumors and establish a predictive model. Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of the predictive ability of the model. Calibration curves and decision curve analysis (DCA) were used to evaluate the model. RESULTS Patients with spontaneous, single-duct, bloody discharge and a smooth ductal wall were more likely to be diagnosed with tumors by ductoscopy. A model was established based on five variables: age, side of discharge, spontaneous discharge status, duration of discharge, and color of discharge. The model was subsequently validated in 183 patients with complete data on the variables in the validation cohort. The area under the ROC curve (AUC) was calculated to be 0.716, indicating good predictive ability. CONCLUSION Patients with the clinical characteristics of unilateral, bloody, single-duct, spontaneous discharge and a smooth ductal wall were more likely to have intraductal tumors by ductoscopy. Our nomogram can effectively predict intraductal tumors in patients with nipple discharge.
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Affiliation(s)
- Bin Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Siyuan Jiang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Lizhe Zhu
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Wei Sheng
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yan Qiao
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jian Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yang Liu
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Na Hao
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xiaoxia Ma
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Can Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yu Ren
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Waaijer L, Filipe MD, Simons J, van der Pol CC, de Boorder T, van Diest PJ, Witkamp AJ. Detection of breast cancer precursor lesions by autofluorescence ductoscopy. Breast Cancer 2020; 28:119-129. [PMID: 32725533 PMCID: PMC7796885 DOI: 10.1007/s12282-020-01136-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/16/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Autofluorescence is an image enhancement technique used for the detection of cancer precursor lesions in pulmonary and gastrointestinal endoscopy. This study evaluated the feasibility of addition of autofluorescence to ductoscopy for the detection of intraductal breast cancer precursor lesions. METHODS An autofluorescence imaging system, producing real-time computed images combining fluorescence intensities, was coupled to a conventional white light ductoscopy system. Prior to surgery, ductoscopy with white light and autofluorescence was evaluated under general anaesthesia in women scheduled for therapeutic or prophylactic mastectomy. Endoscopic findings in both modes were compared, marked and correlated with histology of the surgical specimen. RESULTS Four breast cancer patients and five high-risk women, with a median age of 47 years (range 23-62) were included. In autofluorescence mode, two intraductal lesions were seen in two breast cancer patients, which had an increase in the red-to-green fluorescence intensity compared with the surrounding tissue. One lesion had initially been missed by white light ductoscopy but was clearly visible in subsequent autofluorescence mode. One endoscopic finding was classified as suspicious by white light, but was negative in autofluorescence mode and showed normal histology. CONCLUSIONS This study demonstrates for the first time the in vivo feasibility of autofluorescence ductoscopy to detect pathologically confirmed breast cancer precursor lesions in both breast cancer patients and high-risk women that were occult under white light.
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Affiliation(s)
- Laurien Waaijer
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Janine Simons
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Carmen C van der Pol
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tjeerd de Boorder
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arjen Joost Witkamp
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Zielinski J, Jaworski R, Irga-Jaworska N, Pikula M, Hunerbein M, Jaskiewicz J. Use of fiberoductoscopy for the management of patients with pathological nipple discharge: experience of a single center in Poland. Breast Cancer 2018; 25:753-758. [PMID: 29938367 PMCID: PMC6208849 DOI: 10.1007/s12282-018-0883-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/21/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pathological nipple discharge (PND) is associated with serious clinical and diagnostic issues. Fiberoductoscopy (FDS) is a new diagnostic option in PND patients. This study summarizes our initial experience of FDS for the management of PND patients in a single center in Poland and assesses its safety. METHODS A total of 256 women with PND were included in this prospective, case-controlled, single-center study between 2006 and 2014. Of the 250 patients who underwent FDS, 154 had mammary duct lesions and 96 had no visible lesions. Subsequently, 129 patients with lesions identified by FDS underwent microductectomy and the lesions were pathologically evaluated. RESULTS The mean duration of FDS examination was 17 min. The most frequent intraductal lesion was amputation of a duct (35.1%), followed by circular narrowing or hyperplasia (22.7%). Final histological findings were unremarkable in 11.6% of cases, whereas mammary duct papilloma, duct ectasia, and ductal carcinoma in situ were detected in 71.3, 10.9, and 6.2% of cases, respectively. CONCLUSIONS FDS is an innovative method for visualizing intraductal mammary lesions and allows accurate selection of mammary ducts with suspicious lesions that require surgical removal in women with PND.
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Affiliation(s)
- Jacek Zielinski
- Department of Surgical Oncology, Medical University of Gdansk, Smoluchowski Str 17, 80-214, Gdansk, Poland.
| | - Radoslaw Jaworski
- Department of Cardiac Surgery, Children's Health Memorial Institute, Warsaw, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Michal Pikula
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Michael Hunerbein
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Janusz Jaskiewicz
- Department of Surgical Oncology, Medical University of Gdansk, Smoluchowski Str 17, 80-214, Gdansk, Poland
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Yılmaz R, Bender Ö, Çelik Yabul F, Dursun M, Tunacı M, Acunas G. Diagnosis of Nipple Discharge: Value of Magnetic Resonance Imaging and Ultrasonography in Comparison with Ductoscopy. Balkan Med J 2018; 34:119-126. [PMID: 28418338 PMCID: PMC5394292 DOI: 10.4274/balkanmedj.2016.0184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found. Aims: To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies. Study Design: Diagnostic accuracy study. Methods: Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery. Results: Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis. Conclusion: Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.
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Affiliation(s)
- Ravza Yılmaz
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ömer Bender
- Clinic of General Surgery, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Fatma Çelik Yabul
- Department of Radiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Menduh Dursun
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Mehtap Tunacı
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Gülden Acunas
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Schulz-Wendtland R, Preuss C, Fasching PA, Loehberg CR, Lux MP, Emons J, Beckmann MW, Uder M, Mueller-Schimpfle M. Galactography with Tomosynthesis Technique (Galactomosynthesis) - Renaissance of a Method? Geburtshilfe Frauenheilkd 2018; 78:493-498. [PMID: 29880984 PMCID: PMC5986572 DOI: 10.1055/a-0594-2277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction
For decades, conventional galactography was the only imaging technique capable of showing the mammary ducts. Today, diagnosis is based on a multimodal concept which combines high-resolution ultrasound with magnetic resonance (MR) mammography and ductoscopy/galactoscopy and has a sensitivity and specificity of up to 95%. This study used tomosynthesis in galactography for the first time and compared the synthetic digital 2D full-field mammograms generated with this technique with the images created using the established method of ductal sonography. Both methods should be able to detect invasive breast cancers and their precursors such as ductal carcinoma in situ (DCIS) as well as being able to identify benign findings.
Material and Methods
Five patients with pathological nipple discharge were examined using ductal sonography, contrast-enhanced 3D galactography with tomosynthesis and the synthetic digital 2D full-field mammograms generated with the latter method. Evaluation of the images created with the different imaging modalities was done by three investigators with varying levels of experience with complementary breast diagnostics (1, 5 and 15 years), and their evaluations were compared with the histological findings.
Results
All 3 investigators independently evaluated the images created with ductal sonography, contrast-enhanced 3D galactography with tomosynthesis, and generated synthetic digital 2D full-field mammograms. Their evaluations were compared with the histopathological assessment of the surgical specimens resected from the 5 patients. There was 1 case of invasive breast cancer, 2 cases with ductal carcinoma in situ and 2 cases with benign findings. All 3 investigators made more mistakes when they used the standard imaging technique of ductal sonography to diagnose suspicious lesions than when they used contrast-enhanced galactography with tomosynthesis and the generated synthetic digital 2D full-field mammograms.
Conclusion
This is the first time breast tomosynthesis was used in galactography (galactomosynthesis) to create digital 3-dimensional images of suspicious findings. When used together with the generated synthetic digital 2D full-field mammograms, it could be a useful complementary procedure for the diagnosis of breast anomalies and could herald a renaissance of this method. Compared with high-resolution ductal ultrasound, the investigators achieved better results with contrast-enhanced galactography using tomosynthesis and the generated synthetic digital 2D full-field mammograms, as confirmed by histopathological findings.
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Affiliation(s)
- Rüdiger Schulz-Wendtland
- Radiologisches Institut, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Caroline Preuss
- Frauenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Peter A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Christian R Loehberg
- Frauenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Michael P Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Julius Emons
- Frauenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | - Markus Mueller-Schimpfle
- Klinik für Radiologie - Klinikum Frankfurt Hoechst, DKG-zertifiziertes Brustzentrum, Frankfurt am Main, Germany
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Han Y, Li J, Han S, Jia S, Zhang Y, Zhang W. Diagnostic value of endoscopic appearance during ductoscopy in patients with pathological nipple discharge. BMC Cancer 2017; 17:300. [PMID: 28464874 PMCID: PMC5412041 DOI: 10.1186/s12885-017-3288-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/21/2017] [Indexed: 12/29/2022] Open
Abstract
Background To explore the features of ductoscopic appearance that may be diagnostic in patients with pathologic nipple discharge (PND) and to discuss the diagnostic criteria for intraductal tumors. Methods We reviewed 247 patients with PND but without a palpable mass who were evaluated using either surgical biopsy or excision. Data concerning patient age, duration of discharge, discharge color, and the details of endoscopic appearance were analyzed according to the pathological results. Results The postoperative diagnosis in 61 patients (24.70%) was a nonmass lesion, and 186 patients (76.52%) had an intraductal tumor. Among those with intraductal lesions, 10 patients (4.05%) had a malignant tumor, including 4 (1.62%) with ductal carcinoma in situ and 6 (2.43%) with invasive ductal carcinoma. On univariate analysis, patients of older age with spontaneous and bloody discharge were more likely to suffer from intraductal lesions. On logistic regression analysis, bloody nipple discharge, morphology, and a broad lesion base revealed by ductoscopy showed a statistically significant correlation with malignancy (p = 0.001, p < 0.001, p = 0.022, respectively). Conclusions Both clinical features and endoscopic appearance are significant for the precise diagnosis of an intraductal lesion seen on ductoscopy. The endoscopic features of bloody discharge, morphology, and a broad lesion base are independent risk factors for malignancy and represent new criteria for the diagnosis of patients with PND. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3288-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ye Han
- Mammary Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China. .,Department of Breast Surgery, Shengjing Hospital, China Medical University, Shenyang, 110004, China.
| | - Jianyi Li
- Mammary Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Sijia Han
- Mammary Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Shi Jia
- Mammary Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Yang Zhang
- Mammary Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Wenhai Zhang
- Mammary Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
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Ouldamer L, Kellal I, Legendre G, Ngô C, Chopier J, Body G. [Management of breast nipple discharge: Recommendations]. ACTA ACUST UNITED AC 2015; 44:927-37. [PMID: 26545854 DOI: 10.1016/j.jgyn.2015.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases. RESULTS Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C).
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Affiliation(s)
- L Ouldamer
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
| | - I Kellal
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Legendre
- CESP Inserm U1018, service de gynécologie obstétrique, CHU d'Angers, 49000 Angers, France
| | - C Ngô
- Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP, 15, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, Paris, France
| | - J Chopier
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
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Scheurlen K, Schnitzer A, Krammer J, Kaiser C, Schönberg SO, Wasser K. [Value of galactography for the diagnostic work-up of pathological nipple discharge in multimodal breast diagnostics. Part 2: a systematic review of the literature]. Radiologe 2015; 54:160-6. [PMID: 24233402 DOI: 10.1007/s00117-013-2573-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The survey results of a previous study showed that galactography is now rarely used in Germany and newer methods are applied. The evidential value of galactography should be established and opposed to the evidential value of ultrasound (US) and magnetic resonance mammography (MRM). MATERIALS AND METHODS A search was carried out in PubMed and Cochrane involving studies written in English or German. The level of evidence was measured according to the Oxford Centre for Evidence-based Medicine. RESULTS A total of 19 studies were included, 14 with results on galactography, 10 on US and 5 on MRM. Almost all studies were retrospective with an evidence assigned to level 3b or lower. The results on the diagnostic values showed a very wide range. Because of very variable numbers of cases and consideration of various pathologies, the studies are only comparable to a limited extent. CONCLUSION Galactography, US and MRM all show a weak level of evidence and no superiority of a particular method can be derived. Therefore, galactography can no longer be considered as a mandatory standard in modern multimodal imaging of the breast. Recommendations for the diagnostic work-up of pathological nipple discharge have to be included in current guidelines and must consider these facts.
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Affiliation(s)
- K Scheurlen
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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12
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The significance of ductoscopy of mammary ducts in the diagnostics of breast neoplasms. Wideochir Inne Tech Maloinwazyjne 2014; 10:79-86. [PMID: 25964803 PMCID: PMC4415260 DOI: 10.5114/wiitm.2014.46823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/16/2014] [Accepted: 10/26/2014] [Indexed: 11/25/2022] Open
Abstract
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.
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Lubina N, Schedelbeck U, Roth A, Weng AM, Geissinger E, Hönig A, Hahn D, Bley TA. 3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail. Eur Radiol 2014; 25:1285-93. [PMID: 25433415 DOI: 10.1007/s00330-014-3521-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/08/2014] [Accepted: 11/18/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare 3.0 Tesla breast magnetic resonance imaging (MRI) with galactography for detection of benign and malignant causes of nipple discharge in patients with negative mammography and ultrasound. METHODS We prospectively evaluated 56 breasts of 50 consecutive patients with nipple discharge who had inconspicuous mammography and ultrasound, using 3.0 Tesla breast MRI with a dedicated 16-channel breast coil, and then compared the results with galactography. Histopathological diagnoses and follow-ups were used as reference standard. Lesion size estimated on MRI was compared with the size at histopathology. RESULTS Sensitivity and specificity of MRI vs. galactography for detecting pathologic findings were 95.7 % vs. 85.7 % and 69.7 % vs. 33.3 %, respectively. For the supposed concrete pathology based on MRI findings, the specificity was 67.6 % and the sensitivity 77.3 % (PPV 60.7 %, NPV 82.1 %). Eight malignant lesions were detected (14.8 %). The estimated size at breast MRI showed excellent correlation with the size at histopathology (Pearson's correlation coefficient 0.95, p < 0.0001). CONCLUSIONS MRI of the breast at 3.0 Tesla is an accurate imaging test and can replace galactography in the workup of nipple discharge in patients with inconspicuous mammography and ultrasound. KEY POINTS • Breast MRI is an excellent diagnostic tool for patients with nipple discharge. • MRI of the breast reveals malignant lesions despite inconspicuous mammography and ultrasound. • MRI of the breast has greater sensitivity and specificity than galactography. • Excellent correlation of lesion size measured at MRI and histopathology was found.
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Affiliation(s)
- Nóra Lubina
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
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14
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Ohlinger R, Stomps A, Paepke S, Blohmer JU, Grunwald S, Hahndorf W, Camara O, Deichert U, Peisker U, Kohlmann T, Buchholz I, Hegenscheid K, Utpatel K, Zygmunt M, Hahn M. Ductoscopic Detection of Intraductal Lesions in Cases of Pathologic Nipple Discharge in Comparison with Standard Diagnostics: The German Multicenter Study. Oncol Res Treat 2014; 37:628-32. [DOI: 10.1159/000368338] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022]
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15
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Sarica O, Ozturk E, Demirkurek HC, Uluc F. Comparison of ductoscopy, galactography, and imaging modalities for the evaluation of intraductal lesions: a critical review. Breast Care (Basel) 2013; 8:348-54. [PMID: 24415988 PMCID: PMC3862052 DOI: 10.1159/000355833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Today, in cases of nipple discharge of unclear origin, the abundance of diagnostic procedures - a, diagnostic dilemma' - becomes apparent, because unequivocal indications and a current, standardized examination sequence are presently not available. The diagnostic workup of patients with nipple discharge usually includes the clinical history, physical examination, mammography, ultrasonography, galactography, and nipple discharge cytology, but not ductoscopy. METHODS In this review we analyze and discuss the possible role of ductoscopy in evaluating intraductal pathologies and its combined use with diagnostic imaging modalities. For this purpose, we reviewed and compared the results of the radiological, pathological, and surgical studies independently. CONCLUSIONS Currently, there is no solitary accurate modality to reach our definitive purpose. Being aware of the capability of each diagnostic modality may take us closer to our target. Therefore, adjunct and appropriate use of multiple imaging modalities and ductoscopy is necessary to evaluate patients with nipple discharge.
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Affiliation(s)
- Ozgur Sarica
- Department of Radiology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Enis Ozturk
- Department of Radiology, Bakirkoy Education and Research Hospital, Istanbul, Turkey
| | - Huseyin C. Demirkurek
- Department of Nuclear Medicine, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Fatih Uluc
- Department of Radiology, Taksim Education and Research Hospital, Istanbul, Turkey
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16
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Albrecht C, Thele F, Grunwald S, Kohlmann T, Hegenscheid K, Utpatel K, Zygmunt M, Ohlinger R. Nipple discharge: role of ductoscopy in comparison with standard diagnostic tests. ACTA ACUST UNITED AC 2013; 36:12-6. [PMID: 23429326 DOI: 10.1159/000346639] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Christine Albrecht
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität, Greifswald, Germany
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17
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Kamali S, Bender O, Kamali GH, Aydin MT, Karatepe O, Yuney E. Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer 2012; 21:154-61. [DOI: 10.1007/s12282-012-0377-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/10/2012] [Indexed: 11/29/2022]
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Khan SA, Mangat A, Rivers A, Revesz E, Susnik B, Hansen N. Office ductoscopy for surgical selection in women with pathologic nipple discharge. Ann Surg Oncol 2011; 18:3785-90. [PMID: 21626081 DOI: 10.1245/s10434-011-1791-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathologic nipple discharge (PND) is diagnosed clinically and managed by diagnostic duct excision (DDE). Mammary ductoscopy in the office setting may change this standard. We performed a prospective study to assess the utility of office ductoscopy for surgical selection in women with nipple discharge. METHODS Women with nipple discharge meeting at least 2 of 3 criteria of PND (spontaneous, single duct, bloody or serous) underwent office ductoscopy. Those showing papillomatous lesions underwent DDE in the operating room (surgical group, n = 38); if no lesion was present, women were followed clinically (observation group, n = 21). RESULTS A papillomatous lesion was identified in 79% of women with 3-criteria PND and in 21% with 2 criteria (P = .001). DDE yielded a proliferative lesion in 35 of 38 women (92%). Of the 38, 27 (71%) had papillomata, 2 (5%) had florid hyperplasia, and 6 (16%) had ductal carcinoma in situ (DCIS) on final pathology. Also, 11 women with papilloma and 1 with DCIS presented with 2-criteria PND. Ductoscopy findings were a better predictor of the presence of intraductal neoplasia (area under curve [AUC] 0.9, 95% confidence interval [95% CI] 0.8-0.98) compared with 3-criteria PND (AUC 0.7, 95% CI 0.6-0.8). The 21 women in the observation group did not develop signs of malignancy or need biopsy during a 48-month follow-up period. CONCLUSIONS Our findings suggest that office ductoscopy provides accurate surgical selection of women with nipple discharge and should be considered for women with 2 criteria of PND, and those with negative ductoscopy can be safely observed. These findings need confirmation in a larger study with longer follow-up.
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Affiliation(s)
- Seema A Khan
- Department of Surgery, Lynn Sage Breast Center, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
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19
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Wei H, Jiayi F, Qinping Z, Junyi S, Yuan S, Li L, Dongwei S, Liying Q. Ultrasound-guided vacuum-assisted breast biopsy system for diagnosis and minimally invasive excision of intraductal papilloma without nipple discharge. World J Surg 2010; 33:2579-81. [PMID: 19777298 DOI: 10.1007/s00268-009-0171-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As intraductal papilloma (IP) includes both benign and malignant lesions, it is difficult to decide whether the patient should merely be followed up. The purpose of this study is to validate the ultrasound (US)-guided vacuum-assisted breast biopsy system (Mammotome) for diagnosis and minimally invasive excision of IP. METHODS Six women with breast cystic-solid lesions without nipple discharge underwent B-US-guided 8-gauge Mammotome biopsy. Interval US surveillance was performed at a median time of 7 months (range 5-12 months). RESULTS All lesions were removed accurately and thoroughly with satisfactory cosmetic outcomes. All of them were histologically diagnosed as IP. No clinically significant hematoma developed. CONCLUSIONS The US-guided 8-gauge Mammotome biopsy provides an accurate pathologic diagnosis and successful complete excision of cystic-solid breast lesions. This technique appears to be an alternative to surgical biopsy in IP patients without nipple discharge.
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Affiliation(s)
- Hu Wei
- Department of General Surgery, Changhai Hospital, Second Military Medical University, 200433 Shanghai, China.
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20
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Dooley WC. The Lobar Distribution of the Lesions in Breast Carcinoma: Ductoscopy and Surgery. Breast Cancer 2010. [DOI: 10.1007/978-1-84996-314-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hahn M, Fehm T, Solomayer EF, Siegmann KC, Hengstmann AS, Wallwiener D, Ohlinger R. Selective microdochectomy after ductoscopic wire marking in women with pathological nipple discharge. BMC Cancer 2009; 9:151. [PMID: 19445720 PMCID: PMC2689244 DOI: 10.1186/1471-2407-9-151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/17/2009] [Indexed: 12/05/2022] Open
Abstract
Background To investigate the diagnostic reliability of selective microdochectomy after direct ductoscopic wire marking of suspect lesions in patients with pathological nipple discharge. Methods Selective microdochectomy due to pathological discharge was performed in 33 patients with mean age of 51.7 years. Ductoscopes of 0.9 and 1.1 mm in diameter with a channel for wire marking were used. Only patients without sonographic or mammographic correlation for the discharge were included. The pathologic mammary duct was wire marked and extirpated under direct visual guidance via the ductoscope. The histological results were compared with cytology, galactography and ductoscopy. Results In 24 out of 33 cases (72%) an intraductal, epithelial proliferation was found histologically. The following sensitivities for intraductal, epithelial proliferations could be determined: cytology 4%, galactography 74%, and ductoscopy 78%. Conclusion The method allows selective microdochectomy of the pathological duct and the intraductal proliferation under visual guidance. The resection volume can be reduced in contrast to the unselective ductectomy after injection of methylene blue.
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Affiliation(s)
- M Hahn
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Tuebingen, Germany.
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Dervisoglu E, Kir HM, Kalender B, Eraldemir C, Caglayan C. Depressive symptoms and proinflammatory cytokine levels in chronic renal failure patients. Nephron Clin Pract 2008; 108:c272-7. [PMID: 18418006 DOI: 10.1159/000126907] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 01/10/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cytokine secretion is known to play an important role in the pathophysiology of depression, and levels of proinflammatory cytokines are increased in chronic renal failure (CRF) patients. The objective of this study was to examine the correlation between levels of proinflammatory cytokines in CRF patients and degree of depression. METHODS 31 patients on hemodialysis, 31 patients on continuous ambulatory peritoneal dialysis, and 31 conservatively managed chronic kidney disease (CKD) patients were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI), and 'elevated symptoms of depression' were defined as a BDI score > or =17. IL-6 and TNFalpha cytokine levels were measured by ELISA. RESULTS 'Elevated symptoms of depression' occurred in 37 of 93 patients (40%). IL-6 and TNFalpha levels were not significantly different among CRF patients with and without elevated depressive symptoms (p = 0.937 and p = 0.414, respectively). When analyzed by treatment subgroup, proinflammatory cytokine levels were not significantly different in patients with and without elevated symptoms of depression. CONCLUSION In patients with CRF, elevated symptoms of depression were not associated with increased cytokine levels.
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Affiliation(s)
- Erkan Dervisoglu
- Department of Internal Medicine, Division of Nephrology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
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Zografos GC, Zagouri F, Sergentanis TN. Breast Ductal Endoscopy: Do Not Neglect Education. ACTA ACUST UNITED AC 2008; 31:136. [DOI: 10.1159/000113931] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jacobs VR, Paepke S, Ohlinger R, Grunwald S, Kiechle-Bahat M. Breast Ductoscopy: Technical Development from a Diagnostic to an Interventional Procedure and Its Future Perspective. Oncol Res Treat 2007; 30:545-9. [DOI: 10.1159/000108283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jacobs VR, Paepke S, Schaaf H, Weber BC, Kiechle-Bahat M. Autofluorescence Ductoscopy: A New Imaging Technique for Intraductal Breast Endoscopy. Clin Breast Cancer 2007; 7:619-23. [PMID: 17592674 DOI: 10.3816/cbc.2007.n.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Conventional diagnostic imaging techniques of the female breast, eg, ultrasound, mammography, breast magnetic resonance imaging, or ductography, can only give indirect information about the inside of breast ducts. Diagnostic ductoscopy is the first approach for direct visualization of intraductal lesions. Autofluorescence ductoscopy is a new, noninvasive imaging technique that better identifies intraductal lesions under direct vision. MATERIALS AND METHODS We describe the technical development of autofluorescence ductoscopy and initial experience with early clinical evaluation at Frauenklinik (OB/GYN) of Technical University Munich, Germany, and its potential future application. In contrast to standard white light breast endoscopy, autofluorescence ductoscopy uses a different light spectrum and, after sophisticated data processing, can mark suspicious intraductal lesions in blue-violet colors. Autofluorescence ductoscopy adds new visual information previously not seen in white-light endoscopy. Technical development is completed and clinical evaluation is under way. RESULTS In a small series, the autofluorescence ductoscope was used and confirmed the initial expectations. No complication was expected or occurred. At present time, it is being used on an experimental basis for evaluation of its clinical benefits. CONCLUSION The clinical evaluation of autofluorescence ductoscopy is a work in progress at an early stage. This technique is intended to improve visualization and identification of breast duct walls and lesions and possibly allows an instant visual semiquantitative histologic evaluation of nonbenign ductal lesions.
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Affiliation(s)
- Volker R Jacobs
- Frauenklinik (OB/GYN), Technical University, Munich, Germany.
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