Office ductoscopy for surgical selection in women with pathologic nipple discharge

Seema A. Khan, Amrit Mangat, Aeisha Rivers, Elizabeth Revesz, Barbara Susnik, Nora Hansen

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3785-3790
Number of pages6
JournalAnnals of Surgical Oncology
Volume18
Issue number13
DOIs
StatePublished - Dec 2011

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Carcinoma, Intraductal, Noninfiltrating
Papilloma
Area Under Curve
Observation
Confidence Intervals
Nipple Discharge
Operating Rooms
Hyperplasia
Neoplasms
Breast
Prospective Studies
Pathology
Biopsy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Office ductoscopy for surgical selection in women with pathologic nipple discharge. / Khan, Seema A.; Mangat, Amrit; Rivers, Aeisha; Revesz, Elizabeth; Susnik, Barbara; Hansen, Nora.

In: Annals of Surgical Oncology, Vol. 18, No. 13, 12.2011, p. 3785-3790.

Research output: Contribution to journalArticle

Khan, Seema A. ; Mangat, Amrit ; Rivers, Aeisha ; Revesz, Elizabeth ; Susnik, Barbara ; Hansen, Nora. / Office ductoscopy for surgical selection in women with pathologic nipple discharge. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 13. pp. 3785-3790.
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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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AB - 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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