Valdes Edna K, Boolbol Susan K, Cohen Jean-Marc, Balassanian Ronald, Feldman Sheldon M
Department of Surgery, Louis Venet, MD, Comprehensive Breast Service, Beth Israel Medical Center, 10 East Union Square, Suite 4E, New York, New York, 10003.
Department of Pathology, Beth Israel Medical Center, 10 East Union Square, New York, New York, 10003.
Ann Surg Oncol. 2016 Dec;23(Suppl 5):9015-9019. doi: 10.1245/ASO.2006.08.025. Epub 2006 Jul 29.
Most breast cancers begin in the ductal epithelium with normal cells and progress to atypia and finally to carcinoma. Mammary ductoscopy enables one to directly visualize and sample the ductal epithelium and, therefore, identify early changes cytologically. This article describes our initial experience with mammary ductoscopy at Beth Israel Medical Center.
A prospective review of all patients who underwent ductoscopy at Beth Israel Medical Center from November 2001 to February 2004 was performed. The indications for ductoscopy were a persistent nipple discharge, high-risk status, or intraoperative margin assessment in patients undergoing lumpectomy.
Seventy-four patients underwent ductoscopic evaluation of 88 ducts. Of the 32 patients who underwent office ductoscopy, 15 were high risk, and 17 had spontaneous nipple discharge. Spontaneous nipple discharge was the indication for ductoscopy in 40 of 42 intraoperative procedures. The remaining two patients underwent ductoscopy for margin assessment during breast conservation, and final pathologic analysis revealed negative margins. Thirty-eight of the 40 patients who had spontaneous nipple discharge had abnormal findings during ductoscopy and therefore underwent ductoscopically guided duct excision. Carcinoma was the final diagnosis in 5 (8.8%) of the 57 patients who were scoped for nipple discharge.
Mammary ductoscopy is a potentially useful tool in the evaluation of patients with spontaneous nipple discharge. This is a well-tolerated office procedure with minimal risks and complications. Mammary ductoscopy may have a role in the assessment of high-risk women. Further research is necessary to confirm these potential applications.
大多数乳腺癌起源于具有正常细胞的导管上皮，发展为异型增生，最终演变为癌。乳腺导管镜检查能使人们直接观察和采集导管上皮样本，从而在细胞学上识别早期变化。本文描述了我们在贝斯以色列医疗中心开展乳腺导管镜检查的初步经验。
对2001年11月至2004年2月在贝斯以色列医疗中心接受导管镜检查的所有患者进行前瞻性回顾。导管镜检查的适应证为持续性乳头溢液、高危状态或接受乳房肿块切除术患者的术中切缘评估。
74例患者接受了88条导管的导管镜检查评估。在32例行门诊导管镜检查的患者中，15例为高危患者，17例有自发性乳头溢液。在42例术中操作中，40例的导管镜检查适应证为自发性乳头溢液。其余2例患者在保乳手术期间接受导管镜检查以评估切缘，最终病理分析显示切缘阴性。40例有自发性乳头溢液的患者中，38例在导管镜检查时有异常发现，因此接受了导管镜引导下的导管切除。在57例因乳头溢液接受检查的患者中，5例（8.8%）最终诊断为癌。
乳腺导管镜检查是评估自发性乳头溢液患者的一种潜在有用工具。这是一种耐受性良好的门诊操作，风险和并发症极小。乳腺导管镜检查可能在高危女性评估中发挥作用。需要进一步研究来证实这些潜在应用。
