Hünerbein Michael, Raubach Matthias, Gebauer Bernhard, Schneider Wolfgang, Schlag Peter M
Department of Surgery and Surgical Oncology, Charité Universitätsmedizin Berlin, Campus Berlin Buch and Helios Hospital, Buch, Berlin, Germany.
Breast Cancer Res Treat. 2006 Oct;99(3):301-7. doi: 10.1007/s10549-006-9209-9. Epub 2006 Jun 3.
Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors.
From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen
Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ.
Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.
纤维导管镜检查越来越多地用于评估病理性乳头溢液。该技术的一个主要局限性是无法从可疑的导管内病变获取组织样本。我们提出一种用于腔内肿瘤导管镜活检的新技术。
2002年至2005年，对38例乳头溢液的女性患者使用硬梯度折射率微型内镜（直径0.7mm）和一种特殊的导管内真空辅助活检针进行导管镜检查。术前活检结果与切除标本的组织学结果相关。
38例患者中有37例（97%）成功插管至溢液导管。29例女性（78%）诊断为导管内病变。导管镜检查和乳腺导管造影在检测导管内病变方面的敏感性相当（96%对89%）。除1例病例外，导管内病变的导管镜活检在技术上均获成功。总体而言，活检样本质量良好。28例患者中有26例（93%）获得诊断性活检样本。2份样本含有坏死组织，被认为不具代表性。活检标本的组织学分析显示有22例乳头状瘤、2例原位癌和2例浸润性癌。切除标本的组织学检查在所有病例中均证实了诊断，但有1例额外存在小叶原位癌。
导管镜真空辅助活检是一种用于乳腺导管内病变组织取样的新技术。该方法可能会改善特定患者病理性乳头溢液的术前评估，但不应被视为早期乳腺癌的筛查方法。
