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Fei X, Yong W, Zhang D, Cui J. Advances in fibreoptic ductoscopy for the diagnosis and treatment of pathologic papillary overflow. Heliyon 2024; 10:e23211. [PMID: 38163111 PMCID: PMC10754873 DOI: 10.1016/j.heliyon.2023.e23211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Fibreoptic mammography is widely recognised as the first screening method for pathologic papillary overflow due to its significant advantages in the diagnosis of ductal dilatation, intraductal papilloma and intraductal carcinoma. The use of fibreoptic ductoscopic excisional biopsy techniques, such as biopsy needles, vacuum negative pressure aspiration, biopsy forceps and grasping baskets, has not been promoted largely due to their existing deficiencies. The imaging effect of fibreoptic ductoscopy compared with electronic ductoscopy is also one of the important factors limiting the progress of microscopic excisional biopsy techniques. Finding a more suitable operating space for electronic fibreoptic ductoscopy and the use of electrosurgical excision biopsy techniques should be the focus of research in view of achieving accurate diagnoses in electronic fibreoptic ductoscopy and microscopic excision biopsy. In this review, the development history, clinical application and existing problems of fibreoptic ductoscopy are reviewed and assessed to provide references for the clinical diagnosis and treatment of pathologic papillary overflow.
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Affiliation(s)
- Xiang Fei
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University, China
| | - Wei Yong
- Department of Thyroid and Breast Surgery, Chengdu Seventh People's Hospital (Cancer Hospital Affiliated to Chengdu Medical College), China
| | - Dongxiao Zhang
- Department of Breast, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, China
| | - Jianchun Cui
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University, China
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Makineli S, Filipe MD, Euwe F, Sakes A, Dankelman J, Breedveld P, Vriens MR, van Diest PJ, Witkamp AJ. Feasibility of Narrow-Band Imaging, Intraductal Biopsy, and Laser Ablation During Mammary Ductoscopy: Protocol for an Interventional Study. Int J Surg Protoc 2022; 26:73-80. [PMID: 36118293 PMCID: PMC9438461 DOI: 10.29337/ijsp.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- S. Makineli
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - M. D. Filipe
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - F. Euwe
- Department of Medical Technology and Clinical Physics, University Medical Center, Utrecht, The Netherlands
| | - A. Sakes
- Department of BioMechanical Engineering, Technical University, Delft, The Netherlands
| | - J. Dankelman
- Department of BioMechanical Engineering, Technical University, Delft, The Netherlands
| | - P. Breedveld
- Department of BioMechanical Engineering, Technical University, Delft, The Netherlands
| | - M. R. Vriens
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - P. J. van Diest
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - A. J. Witkamp
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
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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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Network Meta-analysis for the Diagnostic Approach to Pathologic Nipple Discharge. Clin Breast Cancer 2020; 20:e723-e748. [PMID: 32665191 DOI: 10.1016/j.clbc.2020.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 02/07/2023]
Abstract
Pathologic nipple discharge (PND) is one of the most common breast-related complaints for referral because of its supposed association with breast cancer. The aim of this network meta-analysis (NMA) was to compare the diagnostic efficacy of ultrasound, mammogram, cytology, magnetic resonance imaging (MRI), and ductoscopy in patients with PND, as well as to determine the best diagnostic strategy to assess the risk of malignancy as cause for PND. Cochrane Library, PubMed, and Embase were searched to collect relevant literature from the inception of each of the diagnostic methods until January 27, 2020. The search yielded 1472 original citations, of which 36 studies with 3764 patients were finally included for analysis. Direct and indirect comparisons were performed using an NMA approach to evaluate the combined odd ratios and to determine the surface under the cumulative ranking curves (SUCRA) of the diagnostic value of different imaging methods for the detection of breast cancer in patients with PND. Additionally, a subgroup meta-analysis comparing ductoscopy to MRI when conventional imaging was negative was also performed. According to this NMA, sensitivity for detection of malignancy in patients with PND was highest for MRI (83%), followed by ductoscopy (58%), ultrasound (50%), cytology (38%), and mammogram (22%). Specificity was highest for mammogram (93%) followed by ductoscopy (92%), cytology (90%), MRI (76%), and ultrasound (69%). Diagnostic accuracy was the highest for ductoscopy (88%), followed by cytology (82%), MRI (77%), mammogram (76%), and ultrasound (65%). Subgroup meta-analysis (comparing ductoscopy to MRI when ultrasound and mammogram were negative) showed no significant difference in sensitivity, but ductoscopy was statistically significantly better with regard to specificity and diagnostic accuracy. The results from this NMA indicate that although ultrasound and mammogram may remain low-cost useful first choices for the detection of malignancy in patients with PND, ductoscopy outperforms most imaging techniques (especially MRI) and cytology.
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Chang YK, Chen CTH, Wang M, Yang Y, Mark B, Zheng AQ, Kwong A. Could ductoscopy alleviate the need of microdochectomy in pathological nipple discharge? Breast Cancer 2020; 27:607-612. [PMID: 32008216 DOI: 10.1007/s12282-020-01051-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Microdochectomy is the gold-standard for definitive diagnosis for pathological nipple discharge (PND); however, problem of over-treating exists since majority of PND are self-limiting and due to benign causes. Ductoscopy may assist diagnosis, and triage patients for intervention or expectant management. This study aimed to evaluate if ductoscopy could reduce unnecessary microdochectomy but not compromising the diagnosis of malignancy. METHOD A multicenter, retrospective study was conducted in consecutive patients of PND without a suspected malignancy on routine diagnostic evaluation. Ductoscopy was performed with attempts to remove intraductal lesions if they were found. Microdochectomy was carried out if there were positive intraductal lesions, but failed endoscopic extraction, or failed ductoscopy and persistent PND. Efficacy of ductoscopy was determined by cannulation success rate, number of avoided surgery and number of missed malignancy. RESULTS In a 3-year period between 2016 and 2018, a total of 223 ductoscopy were performed and 94.2% had successful cannulation. Within such, 59.5% (N = 125) had intraductal mass identified, and 82 microdochectomy were carried out. The final histology showed 15 malignancy, making the overall malignancy rate 6.7%. Ductoscopy successful and negative patients (N = 85, 37.8%) were triaged for surveillance and the malignancy rate is 0% in a median follow-up of 2 years; hence, microdochectomy was avoided. CONCLUSION PND with non-suspicious conventional imaging and negative ductoscopy have rare malignancy rate which makes subsequent microdochectomy unnecessary. However, intraductal mass in ductoscopy is a predictor for malignancy so definitive histology diagnosis is mandatory.
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Affiliation(s)
- Yuk-Kwan Chang
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | | | - Min Wang
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Yong Yang
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Bonita Mark
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Ai-Qiu Zheng
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China. .,Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.
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Filipe MD, Waaijer L, van der Pol C, van Diest PJ, Witkamp AJ. Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience. Clin Breast Cancer 2020; 20:e334-e343. [PMID: 32081573 DOI: 10.1016/j.clbc.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Pathologic nipple discharge (PND) is, after palpable lumps and pain, the most common breast-related reason for referral to the breast surgeon and is associated with breast cancer. However, with negative mammography and ultrasound, the chance of PND being caused by malignancy is between 5% and 8%. Nevertheless, most patients with PND still undergo surgery in order to rule out malignancy. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization. The aim of this study was to evaluate (interventional) ductoscopy as an alternative to surgery in patients with negative conventional imaging. MATERIALS AND METHODS All patients with PND referred between 2010 and 2017 to our hospital for ductoscopy were retrospectively analyzed. Ductoscopy procedures were performed under local anesthesia in the outpatient clinic. The follow-up period was at least 3 months, and the primary outcome was the number of prevented surgical procedures. Furthermore, we evaluated possible complications after ductoscopy (infection and pain). RESULTS A total of 215 consecutive patients undergoing ductoscopy were analyzed. In 151 (70.2%) patients, ductoscopy was successful. In 102 procedures, an underlying cause for PND was visualized, of which 34 patients could be histologically proven and 82 patients treated. Sixty of the 215 patients were eventually operated, 8 owing to suspicious findings during ductoscopy, 42 owing to persistent PND, and 10 because of recurrent PND. In 7 patients, a malignancy was found (5 of them classified as suspicious at dusctoscopy). No serious side effects were seen. CONCLUSION Ductoscopy can be safely used as an alternative for surgery in the workup for PND.
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Affiliation(s)
- Mando Dyko Filipe
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands.
| | - Laurien Waaijer
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands
| | - Carmen van der Pol
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands
| | | | - Arjen Joost Witkamp
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands
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