Fiberoptic ductoscopy findings in women with and without spontaneous nipple discharge
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Abstract BACKGROUND Fiberoptic ductoscopy (FD), which allows direct visualization of the breast ductal lumen, is performed in women with and without spontaneous nipple discharge (SND). Previous reports suggested that cytologic evaluation of SND may be falsely interpreted as containing malignancy. The purpose of the current study, which was performed prospectively, was to determine whether ductoscopic findings were different in women with versus without SND, and to assess the implications of the differences in SND versus non‐SND samples regarding the role of FD in assessing whether a woman has breast carcinoma. METHODS Data were collected on the distance traveled by the ductoscope, visual observations, pathology, cytology, epithelial and foam cell quantity, and image analysis for ploidy, hypertetraploidy, and S‐phase fraction. RESULTS Of 100 FD specimens, 60 were from breasts without SND and 40 were from breasts with SND. Intraductal visual observations ( P ≤ 0.0002), pathologic findings in the resected specimen ( P ≤ 0.001), and quantity of epithelial cells ( P = 0.03) were influenced by the presence or absence of SND. Although one specimen from a benign breast was interpreted as cytologically malignant, every breast with both malignant cytology and aneuploidy contained cancer cells. A model incorporating cytology and SND was 92% sensitive and 60% specific in predicting which women had breast carcinoma. CONCLUSIONS There were pronounced differences in FD samples from women with and without SND. FD biologic parameters can be chosen to optimize breast carcinoma predictive sensitivity and specificity. SND cytology can present a diagnostic problem, suggesting the need for histologic confirmation before the initiation of therapy. Cancer 2005. © 2005 American Cancer Society.Keywords:
Nipple discharge
Breast carcinoma
To evaluate sensitivity of effusion cytology in detecting malignancy.Effusion cytology was studied from 37 malignancy associated and 28 non malignancy associated ascitic fluid samples.Out of 65 cases, 44 (67.7%) effusions were reported negative, 15 (23.1%) were positive and 6 (9.2%) were suspicious for malignancy. Thus total 21 effusions (32.3%) were tumour cell positive. All 21 (100%) were true positive, none (0%) was false positive, 28 (63.6%) were true negative and 16 (36.4%) were false negative. Thus ascitic fluid cytology had sensitivity of 56.7% and specificity of 100%. Predictive value of positive test and negative test was 100% and 63.6% respectively. Stomach was the most common primary site of malignancy associated with ascites (11/37 i.e. 29.7%) where as adenocarcinoma was the most common type of malignancy (11/15 i.e.73.3%) in ascitic fluid cytology.Ascitic fluid cytology is a simple and useful procedure with sensitivity of 56.7% and should be routinely requested.
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BACKGROUND:
The aim of this study is to identify and analyse patients presenting to the general surgical outpatient department with breast related complaints such as breast pain and nipple discharge without the presence of history of breast lump to aid in the identifying the incidence of carcinoma breast in these patients.
PATIENTS AND METHODS:
Our study includes 50 patients who present to the general surgical out patient department with the history of complaints of breast related complaints such as breast pain and nipple discharge without the presence of breast lump.
RESULTS:
In our study, we have identified that the most common diagnosis to be made in patients who present to the general surgical out patient department with breast related complaints was found to be Aberrations in Normal Development and Involution (ANDI) which consisted of diseases such as fibrocystic disease of breast and fibroadenoma. It was found that carcinoma breast was diagnosed with a frequency of much less than benign breast diseases and the incidence of carcinoma breast was found to be very minimal in comparing to benign breast diseases.
CONCLUSION:
The most common disease in the female population with breast related complaints such as breast pain and nipple discharge without the presence of breast lump is found to be Aberrations in Normal Development and Involution (ANDI). Carcinoma breast is diagnosed with very less frequency than benign breast diseases in patients presenting with these type of complaints. But, the clinical suspicion of carcinoma breast should always be kept in mind and further evaluation of female patients should always be done who present to the out patient department with breast related complaints.
Nipple discharge
Breast carcinoma
Breast pain
Breast disease
Outpatient clinic
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The aim of this study is to report our experience with ductoscopic evaluation for screening patients with nipple discharge and evaluate any potential indications and benefits of ductoscopy. From January 2010 to December 2012, 419 female patients with nipple discharge were enrolled in this study. All patients involved in this study showed no mass in ultrasound and mammography. Data concerning age, clinical characteristics of nipple discharge, nipple discharge cytology, ductoscopic and postsurgical diagnosis, and complications were statistically analyzed. Ductoscopy examinations were completed in 405 patients (96.66%). For these 405 patients, there were 519 ductoscopic investigations. 112 (27.65%) patients were found to have intraductal papillary lesions of which 62 were operated in our hospital. Postsurgical diagnosis showed 8 (12.9%) malignancy including 6 DCIS and 2 invasive ductal carcinomas. All of the 8 patients meet at least two criteria of pathologic nipple discharge (single duct, spontaneous, bloody nipple discharge). The other patients with nonpapillary lesions are still under surveillance. By univariate analysis, patients with unilateral, single duct, spontaneous and bloody nipple discharge were more likely to have intraductal papillary lesions. By multivariate analysis, unilateral, spontaneous, and bloody nipple discharge showed statistically significant correlations with intraductal papillary lesions revealed by ductoscopy. Ductoscopy is a safe and efficient investigation in preoperative screening of the patients with nipple discharge. Clinical characteristics have predictive value in selection of patients for ductoscopical investigation. Patients with clinical characteristics of unilateral, spontaneous, and bloody nipple discharge were more likely to have intraductal papillary lesions revealed by ductoscopy.
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Bloody
Intraductal papilloma
Univariate analysis
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Abstract Background Nipple discharge is one of the commonest encountered complaints in the field of breast imaging. Excluding malignancy as a cause of pathological nipple discharge is of utmost importance. Our aim in this study was to assess the role of contrast-enhanced spectral mammography (CESM) in the diagnostic workup of patients with pathological nipple discharge (PND). Results In the current prospective study, 59/140 lesions were benign and 81/140 lesions were malignant. Analysis of CESM had achieved a higher sensitivity of 97.5% and a similar specificity of 54.2% as compared to sono-mammography, which achieved a sensitivity of 92.6% and specificity of 54.2%. The diagnostic accuracy of CESM was higher (79.3%) than sono-mammography (76.3%). CESM performed better than sono-mammography in the assessment of disease extent, as it was able to detect multifocality, multicentricity, and diffuse abnormalities, which were found in 24.1%, 43.0% and 8.9% of cases, respectively, as compared to 20.5%, 37.2%, and 3.8% of cases by sono-mammography. Conclusion CESM can be a valuable diagnostic imaging tool in the detection of malignancy associated with PND if sono-mammographic findings are equivocal. Its greater impact is on the delineation of disease extent, which will alter the treatment strategy.
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Introduction Between 16,000 and 48,000 women are estimated to present to UK breast clinics with nipple discharge each year. The incidence of malignancy in these women is 2.7–24.2%. Currently, there is no consensus on the best way to investigate and manage these women. The aim of this study was to assess the rate of malignancy in women presenting with unilateral nipple discharge, and to evaluate the role of examination, imaging and cytology in reliably predicting outcome. Methods Breast units were asked to prospectively collect data on all new patients with unilateral nipple discharge. Data collected included discharge colour, whether it was uniductal or multiductal, examination and imaging findings, cytology results and outcome. Results Complete datasets were submitted by 5 units on 228 patients. The incidence of malignancy was 4.4%. Clinical examination was valuable in detecting malignancy and multiductal discharge was not related to malignancy. The positive predictive value for detecting malignancy for an abnormality found on mammography was 53.5% and for ultrasonography, it was 65.2%. The role of cytology in detecting malignancy was inconclusive with positive predictive values of the presence of red blood cells and epithelial cells at 6.1% and 10.7% respectively. Conclusions A large number of women are investigated for nipple discharge (with huge resource implications) but there is little reliable evidence on the best way to investigate and manage these patients. A larger study is needed to evaluate the role of investigations in nipple discharge to produce guidelines on optimal management.
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Abnormality
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Intraductal papilloma
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Objective:To assess the value of fiberoptic ductoscopy in the diagnosis and treatment of nipple discharge.Methods:Fiberoptic ductoscopy was used to check 150 cases with nipple discharge from July 2009 to October 2010 in our hospital,and then to compare the preoperative clinical diagnosis with pathologic diagnosis in patients with nipple discharge.Results:150 cases were checked successfully.3 cases were diagnosed with breast cancer and 62 cases wer papilloma.The coincidence rate of clinical diagnosis and pathological diagnosis is about 66.7% and 88.7% respectively;85 cases wre diagnosed with mammary ductectasia with duct inflammation.After ductal lavagedrugs,the nipple discharge have significantly improved or curde.Conclusion: Fiberoptic ductoscopy was the preferred method in diagnosis of nipple discharge.It could clear the cause of nipple discharge in a more intuitionistic and accurate way and define the position and size of the nipple discharge;it could make the duct inflammation and duct ectasia patients free from operation.Also Fiberoptic ductoscopy was an effective technique in diagnosis of breast intraductal papilloma and intraductal carcinoma with nipple discharge as the main performance.
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Intraductal papilloma
Ectasia
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Abstract We prospectively performed cytologic assessment and image analysis (IA) on matched nipple aspirate fluid (NAF) and mammary ductoscopy (MD) specimens to determine (1) the accuracy of these methods in cancer detection and (2) whether the two collection methods provide complementary information. NAF and MD specimens were collected from 84 breasts from 75 women (nine bilateral samples) who underwent breast surgery. Cytologic evaluation was performed on all samples. IA was performed on slides with sufficient epithelial cells. Cytologic evaluation proved more accurate in patients without pathologic spontaneous nipple discharge (PND) than those with PND, mainly because of the potential false positive diagnosis in the latter. While the sensitivity of NAF and MD cytology was low (10% and 14%, respectively), both were 100% specific in cancer detection in the non‐PND cohort. Combining NAF and MD cytology information improved sensitivity (24%) without sacrificing specificity. Similar to cytology, IA was more accurate in patients without PND having high specificity (100% for aneuploid IA), but relatively low sensitivity (36%). Combining NAF and MD cytology with aneuploid IA improved the sensitivity (45%) while maintaining high specificity (100%). The best predictive model was positive NAF cytology and/or MD cytology combined with IA aneuploidy, which resulted in 55% sensitivity and 100% specificity in breast cancer detection. Cytologic evaluation and IA of NAF and MD specimens are complementary. The presence of atypical cells arising from an intraductal papilloma in ductoscopic specimens is a potential source of false positive diagnosis in patients with nipple discharge. Diagn. Cytopathol. 2010 © 2009 Wiley‐Liss, Inc.
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Intraductal papilloma
Positive predicative value
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Objective
To study the diagnostic and therapeutic value of fiberoptic ductoscopy (FDS) in nipple discharge.
Methods
The clinical data of three hundred cases with nipple discharge from Subei People’s Hospital of Jiangsu Province from August 2012 to June 2016 were retrospectively analyzed.
Results
The rates of tumor detection by FDS were significantly higher of bloody and serous nipple discharge (80.0%, 52.2%) than milky and watery nipple discharge (4.0%, 3.2%). For patients with breast inflammatory nipple discharge, local drug douching via FDS was an effective treatment. The diagnostic rate of localization via FDS was significantly higher than that of breast duct infusion of methylene blue (95.0% vs 87.5%, χ2=1.834, P=0.176).
Conclusions
FDS is an accurate method for diagnosing patients with nipple discharge. In addition, it is also good local drug douching method for patients with breast inflammatory nipple discharge. For patients with tumorous nipple discharge, localization via FDS can help improve the detection of the lesions, which can be removed by surgery.
Key words:
Papilloma; Breast diseases; Fiberoptic ductoscopy
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Intraductal papilloma
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