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Ductoscopy May Aid Diagnosis of Nipple Discharge.

SAN ANTONIO -- Mammary fiberoptic ductoscopy is a useful emerging technique in the diagnosis of pathologic nipple discharge, Dr. Jill R. Dietz said at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

Breast cancer frequently arises in the milk ducts. Direct visualization into the distal ductal system often detects malignant or premalignant lesions deep inside that went unsuspected upon mammography and ductography, explained Dr. Dietz, a surgeon at the Cleveland Clinic Foundation.

Ductoscopy is also of value in directing surgical excision of the pathologic duct. It enables the surgeon to take far less tissue while ensuring that the target lesion has actually been removed.

Many women who've undergone conventional ductal surgery for pathologic nipple discharge are unable to breast-feed thereafter. Dr. Dietz believes that ductoscopy-guided minimally invasive surgery will allow most of her patients to breast-feed, although she doesn't yet have sufficient patient numbers to prove it.

She presented a phase I study in which intraoperative ductoscopy using an Acueity 1.2-mm semirigid fiberoptic ducto- scope was attempted in 51 conscious patients with pathologic nipple discharge. All were given intravenous sedation and four quadrant nipple block with local anesthesia before nipple orifice cannulation and exploration.

The symptomatic duct or ducts were successfully cannulized in all cases. The procedure was well tolerated. Pathologic abnormalities were visualized in 48 of 51 patients. In the remaining three, an obliterated duct or false tract prevented visualization.

The most common finding was a papillary lesion, which was present in 36 women. Ductal carcinoma in situ was found in five patients; most of these appeared as papillary exophytic lesions. His tologically confirmed hyperplasia was de tected in seven patients.

Forty women underwent preoperative ductography, which was unable to localize the lesion in 10 cases. Ductoscopy successfully localized the pathology in 9 of these 10. Ductoscopy also identified six significant lesions that hadn't been apparent on ductography.

Leaving the ductoscope in place greatly simplifies precise surgical removal of pathologic tissue. The surgeon uses the ductoscope as a guide in dissecting along the duct until reaching the tip of the in strument, where the point of fiberoptic light marks the location of the target.
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Publication:OB GYN News
Date:Apr 1, 2001
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