Office Ductoscopy for Surgical Selection in Women with Pathologic Nipple Discharge

• Published in: Annals of surgical oncology Vol. 18; no. 13; pp. 3785 - 3790
• Main Authors: Khan, Seema A., Mangat, Amrit, Rivers, Aeisha, Revesz, Elizabeth, Susnik, Barbara, Hansen, Nora
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-12-2011; Springer Nature B.V
• Subjects: Adult; Aged; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Endoscopy; Exudates and Transudates; Female; Follow-Up Studies; Humans; Hyperplasia - pathology; Hyperplasia - surgery; Medicine; Medicine & Public Health; Middle Aged; Nipples - pathology; Nipples - surgery; Oncology; Papilloma - pathology; Papilloma - surgery; Patient Selection; Predictive Value of Tests; Prospective Studies; Surgery; Surgical Oncology; Intraductal Papilloma; Pathologic Nipple Discharge; Nipple Discharge; Mammary Ductoscopy; Bloody Nipple Discharge
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-1791-3

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.