- William C Dooley, MD, FACS
William C Dooley, MD, FACS
- Professor of Surgery
- The University of Oklahoma College of Medicine
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Mammary ductoscopy is an endoscopic technique that allows for direct visualization and sampling of intraductal lesions [1-7]. Ductoscopy has been used more widely in breast surgery in Asia with the advent of durable submillimeter endoscopes and duct distention techniques. However, ductoscopy is not commonly performed in the United States [8-16].
In this topic, we discuss the use of ductoscopy to diagnose and treat conditions such as pathologic nipple discharge and early-stage breast cancer. Other aspects of nipple discharge are discussed elsewhere. (See "Nipple discharge" and "Surgical management of pathologic nipple discharge".)
Ductoscopy provides a way to directly visualize and sample or excise lesions in the mammary ducts. The indications for performing a ductoscopy include:
●Pathologic nipple discharge from a single duct orifice (bloody or high-volume clear fluid)
●Known breast lesions (atypical ductal hyperplasia [ADH], ductal carcinoma in situ [DCIS], or invasive cancer) with expressible nipple fluid
- Okazaki A, Okazaki M, Asaishi K, et al. Fiberoptic ductoscopy of the breast: a new diagnostic procedure for nipple discharge. Jpn J Clin Oncol 1991; 21:188.
- Shao ZM, Nguyen M. Nipple aspiration in diagnosis of breast cancer. Semin Surg Oncol 2001; 20:175.
- Matsunaga T, Ohta D, Misaka T, et al. Mammary ductoscopy for diagnosis and treatment of intraductal lesions of the breast. Breast Cancer 2001; 8:213.
- Yamamoto D, Shoji T, Kawanishi H, et al. A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge. Breast Cancer Res Treat 2001; 70:103.
- Shen K, Lu J, Yuan J, et al. [Fiberoptic ductoscopy for patients with intraductal papillary lesions]. Zhonghua Wai Ke Za Zhi 2000; 38:275.
- Yamamoto D, Ueda S, Senzaki H, et al. New diagnostic approach to intracystic lesions of the breast by fiberoptic ductoscopy. Anticancer Res 2001; 21:4113.
- Okazaki A, Okazaki M, Watanabe Y, Hirata K. [Diagnostic significance of mammary ductoscopy for early breast cancer]. Nihon Rinsho 2007; 65 Suppl 6:295.
- Dooley WC. Endoscopic visualization of breast tumors. JAMA 2000; 284:1518.
- Dooley WC. Routine operative breast endoscopy for bloody nipple discharge. Ann Surg Oncol 2002; 9:920.
- Dooley WC. Routine operative breast endoscopy during lumpectomy. Ann Surg Oncol 2003; 10:38.
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- Dietz JR, Crowe JP, Grundfest S, et al. Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery 2002; 132:582.
- Hünerbein M, Estévez Schwarz L, Schneider U, Schlag PM. Evaluation of pathologic nipple discharge with ductoscopy. J Am Coll Surg 2003; 197:697.
- Love SM, Barsky SH. Breast-duct endoscopy to study stages of cancerous breast disease. Lancet 1996; 348:997.
- Dooley WC, Ljung BM, Veronesi U, et al. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst 2001; 93:1624.
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- Moncrief RM, Nayar R, Diaz LK, et al. A comparison of ductoscopy-guided and conventional surgical excision in women with spontaneous nipple discharge. Ann Surg 2005; 241:575.
- Dooley WC, Francescatti D, Clark L, Webber G. Office-based breast ductoscopy for diagnosis. Am J Surg 2004; 188:415.
- Dooley WC, Spiegel A, Cox C, et al. Ductoscopy: defining its role in the management of breast cancer. Breast J 2004; 10:271.
- Makita M, Akiyama F, Gomi N, et al. Endoscopic and histologic findings of intraductal lesions presenting with nipple discharge. Breast J 2006; 12:S210.
- Valdes EK, Feldman SM, Balassanian R, et al. Diagnosis of recurrent breast cancer by ductoscopy. Breast J 2005; 11:506.
- Dooley WC. The future prospect: ductoscopy-directed brushing and biopsy. Clin Lab Med 2005; 25:845.
- Sauter E. Breast cancer detection using mammary ductoscopy. Future Oncol 2005; 1:385.
- Evron E, Dooley WC, Umbricht CB, et al. Detection of breast cancer cells in ductal lavage fluid by methylation-specific PCR. Lancet 2001; 357:1335.
- Dooley WC. Ductal lavage, nipple aspiration, and ductoscopy for breast cancer diagnosis. Curr Oncol Rep 2003; 5:63.
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- Hung WK, Ying M, Chan CM, et al. Minimally invasive technology in the management of breast disease. Breast Cancer 2009; 16:23.
- Okazaki A, Okazaki M, Hirata K, Tsumanuma T. [Progress of ductoscopy of the breast]. Nihon Geka Gakkai Zasshi 1996; 97:357.
- Okazaki A, Hirata K, Okazaki M, et al. Nipple discharge disorders: current diagnostic management and the role of fiber-ductoscopy. Eur Radiol 1999; 9:583.
- Shen KW, Wu J, Lu JS, et al. Fiberoptic ductoscopy for patients with nipple discharge. Cancer 2000; 89:1512.
- Shao ZM, Liu Y, Nguyen M. The role of the breast ductal system in the diagnosis of cancer (review). Oncol Rep 2001; 8:153.
- Shen KW, Wu J, Lu JS, et al. Fiberoptic ductoscopy for breast cancer patients with nipple discharge. Surg Endosc 2001; 15:1340.
- Makita M, Akiyama F, Gomi N, et al. Endoscopic classification of intraductal lesions and histological diagnosis. Breast Cancer 2002; 9:220.
- Tamaki Y, Miyoshi Y, Noguchi S. [Application of endoscopic surgery for breast cancer treatment]. Nihon Geka Gakkai Zasshi 2002; 103:835.
- Uchida K, Fukushima H, Toriumi Y, et al. Mammary ductoscopy: current issues and perspectives. Breast Cancer 2009; 16:93.
- Hünerbein M, Dubowy A, Raubach M, et al. Gradient index ductoscopy and intraductal biopsy of intraductal breast lesions. Am J Surg 2007; 194:511.
- Jacobs VR, Paepke S, Schaaf H, et al. Autofluorescence ductoscopy: a new imaging technique for intraductal breast endoscopy. Clin Breast Cancer 2007; 7:619.
- Uchida K, Toriumi Y, Kawase K, et al. Percutaneous endoscopy-guided biopsy of an intracystic tumor with a mammary ductoscopy. Breast Cancer 2007; 14:215.
- Liu GY, Lu JS, Shen KW, et al. Fiberoptic ductoscopy combined with cytology testing in the patients of spontaneous nipple discharge. Breast Cancer Res Treat 2008; 108:271.
- Grunwald S, Heyer H, Paepke S, et al. Diagnostic value of ductoscopy in the diagnosis of nipple discharge and intraductal proliferations in comparison to standard methods. Onkologie 2007; 30:243.
- Sauter ER, Klein-Szanto A, Ehya H, MacGibbon B. Ductoscopic cytology and image analysis to detect breast carcinoma. Cancer 2004; 101:1283.
- Pathologic nipple discharge
- Early-stage breast cancer with expressible nipple fluid
- Prior nipple surgery
- Multiduct or nonreproducible discharge
- PREOPERATIVE EVALUATION AND PREPARATION
- Preoperative imaging
- Preoperative hydration
- SURGICAL ANATOMY
- OPERATIVE MANAGEMENT
- Initial steps
- Subsequent steps
- - Pathologic nipple discharge
- Multiple lesions
- - Early-stage breast cancer
- Alternative (Asian) technique
- PATHOLOGIC EVALUATION
- POSTOPERATIVE CARE
- SUMMARY AND RECOMMENDATIONS