Annals of Surgical Oncology

, 18:3187 | Cite as

A Look into the Ductoscope: Its Role in Pathologic Nipple Discharge

American Society of Breast Surgeons



Mammary ductoscopy allows direct visualization of the ductal system and a method for directed excision and pathologic diagnosis. We reviewed our experience with mammary ductoscopy in the evaluation of pathologic nipple discharge.


We reviewed all patients who underwent ductoscopy for pathologic nipple discharge at our institution from 2006–2010. All procedures were performed by a single surgeon. Data included patient and imaging characteristics, indications, operative findings, and pathologic outcomes. Descriptive statistics were used for data summary.


During the study period, 121 patients underwent ductoscopy and directed duct excision for pathologic nipple discharge, including 66 (55%) with bloody discharge. Breast imaging [mammography, ultrasound, and/or magnetic resonance imaging (MRI)] revealed BIRADS category I/II/III findings in 112 (93%), BIRADS category IV findings in 6 (5%), and was unknown in 3 (2%) patients. Final pathology revealed papillomas in 64 (53%) patients, duct ectasia and associated benign findings in 48 (40%) patients, ductal carcinoma in situ (DCIS) in 7 (6%) patients, and atypical ductal hyperplasia in 2 (1%) patients. None of the patients with DCIS underwent preductoscopy MRI, but all had BIRADS category I/II/III breast imaging. The extent of DCIS identified by ductoscopy and subsequent surgical excision ranged from <1 cm to 10 cm (median 3 cm).


The majority of patients with pathologic nipple discharge have benign nonproliferative findings or benign papillomas. Although atypia and malignancy were diagnosed in only 7% of patients who underwent ductoscopy for pathologic nipple discharge, there were no routine imaging findings indicative of these diagnoses preoperatively.


Nipple Atypical Ductal Hyperplasia Nipple Discharge Intraductal Papilloma Intraductal Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Dietz JR, Crowe JP, Grundfest S, et al. Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery. 2002;132:582–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Morrogh M, Morris EA, Liberman L, et al. The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 2007;14:3369–77.PubMedCrossRefGoogle Scholar
  3. 3.
    Cabioglu N, Hunt KK, Singletary SE, et al. Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. J Am Coll Surg. 2003;196:354–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Okazaki A, Okazaki M, Asaishi K, et al. Fiberoptic ductoscopy of the breast: a new diagnostic procedure for nipple discharge. Jpn J Clin Oncol. 1992;21:188–93.Google Scholar
  5. 5.
    Kapenhas-Valdes E, Feldman SM, Boolbol SK. The role of mammary ductoscopy in breast cancer: a review of the literature. Ann Surg Oncol. 2008;15:3350–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Dooley WC. Breast ductoscopy and the evolution of the intra-ductal approach to breast cancer. Breast J. 2009;15(Suppl 1):90–4.CrossRefGoogle Scholar
  7. 7.
    Lau S, Kuchenmeister I, Stachs A, et al. Pathologic nipple discharge: surgery is imperative in postmenopausal women. Ann Surg Oncol. 2005;12:546–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J. 2004;10:111–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Kamali S, Bender O, Aydin MT, Yuney E, Kamali G. Ductoscopy in the evaluation and management of nipple discharge. Ann Surg Oncol. 2010;17:778–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Lamont JP, Dultz RP, Kuhn JA, et al. Galactography in patients with nipple discharge. Proc (Bayl Univ Med Cent). 2000;13:214–6.Google Scholar
  11. 11.
    Van Zee KJ, Ortega Perez G, Minnard E, Cohen MA. Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge. Cancer. 1998;82:1874–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Hou MF, Huang TJ, Liu GC. The diagnostic value of galactography in patients with nipple discharge. Clin Imaging. 2001;25:75–81.PubMedCrossRefGoogle Scholar
  13. 13.
    Nakahara H, Namba K, Watanabe R, et al. A comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer. 2003;10:320–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Ishikawa T, Momiyama N, Hamaguchi Y, et al. Evaluation of dynamic studies of MR mammography for the diagnosis of intraductal lesions with nipple discharge. Breast Cancer. 2004;11;288–94.PubMedCrossRefGoogle Scholar
  15. 15.
    Tjalma WA, Verslegers IO. Nipple discharge and the value of MR imaging. Eur J Obstet Gynecol Reprod Biol. 2004;115:234–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Mortellaro VE, Marshall J, Harms SE, et al. Breast MR for the evaluation of occult nipple discharge. Am Surg. 2008;74:739–42.PubMedGoogle Scholar
  17. 17.
    Shen KW, Wu J, Lu JS, et al. Fiberoptic ductoscopy for breast cancer patients with nipple discharge. Surg Endosc. 2001;15:1340–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Dooley WC. Routine operative breast endoscopy for bloody nipple discharge. Ann Surg Oncol. 2002;9:920–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Kapenhas-Valdes E, Feldman SM, Cohen JM, Boolbol SK. Mammary ductoscopy for evaluation of nipple discharge. Ann Surg Oncol. 2008;10:2720–7.CrossRefGoogle Scholar
  20. 20.
    Vaughan A, Crowe JP, Brainard J, et al. Mammary ductoscopy and ductal washings for the evaluation of patients with pathologic nipple discharge. Breast J. 2009;15:254–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Tang SSK, Twelves DJ, Isacke CM, Gui GPH. Mammary ductoscopy in the current management of breast disease. Surg Endosc. 2010;25:1712–22.Google Scholar
  22. 22.
    Louie LD, Crowe JP, Dawson AE, et al. Identification of breast cancer in patients with pathologic nipple discharge: does ductoscopy predict malignancy? Am J Surg. 2006;192:530–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Kocdor MA, Sevinc AI, Canda T, et al. Pathologic nipple discharge in patients with radiologically invisible mass: review of 28 consecutive sub-areolar explorations. Breast J. 2009;15(3):230–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Holloway CM, Easson A, Escallon J, et al. Technology as a force for improved diagnosis and treatment of breast disease. Can J Surg. 2010;53(4):268–77.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  1. 1.Department of SurgeryWashington University School of MedicineSt. LouisUSA

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