Background/Objectives : We investigated the feasibility of ductoscopy in diagnosis and management of patients presenting with clinically pathological nipple discharge (PND). Methods: Mammary ductoscopy was performed on 57 breasts with PND in 54 patients for diagnostic and therapeutic purposes. Ductoscopic abnormalities included ductal irregularities, presence of erythematous patches, or presence of intraductal papillomas, whereas duct ectasia or presence of dense fluid was considered a benign finding. Results: Age older than 40 and any pathology in ultrasound or ductoscopy were significantly associated with a decision of surgery. Surgical procedures included central duct excisions (n = 16) or specific duct excisions (n = 14) guided by either ultrasound (USG) or ductoscopy. Presence of an abnormal finding on ductoscopy was significantly associated with a specific lesion yield for PND in 18 patients, such as ductal carcinoma in situ with/without papillary cancer (n = 2, 11.1%), or intraductal papilloma/papillomatosis (n = 15, 83.3%) or periductal mastitis (n = 1, 5.6%) (specific lesion for PND; ductoscopic abnormality: 83.3% (15/18) vs. ductoscopic benign findings: 16.7% (2/12); p = 0.001) in patients undergoing surgical intervention. However, pathological findings in other imaging modalities including USG, magnetic resonance imaging (MRI) or mammogram were not associated with specific lesion yield for PND. The cancer detection rate in surgically excised lesions (n = 30) was 6.7% (n = 2). Overall, nipple discharge ceased in three patients who were conservatively observed after benign findings on ductoscopy at a median of 58 months (IQR, 39–77). Conclusions: The use of ductoscopy facilitated surgical decision-making in patients with PND, helping to distinguish patients requiring surgical excision from those suitable for conservative follow-up. In this cohort, ductoscopy findings were frequently associated with specific lesions, including mostly intraductal papilloma, explaining nipple discharge in patients selected for surgery.

Innovative use of optical coherence tomography catheter via nipple orifice: a case report of first intraductal images of florid ductal hyperplasia

Background: Ductoscopic resolution is insufficient to distinguish the flat lesions and microcalcifications that indicate malignancy in patients with pathologic nipple discharge (PND). This study evaluated the feasibility of imaging intraductal epithelial layers, premalignant, or malignant lesions using catheter-integrated optical coherence tomography (OCT) through the nipple orifices. Methods: Mastectomy specimens were prospectively obtained from patients who had undergone simple or skin-sparing mastectomies for either malignancy (n = 14) or prophylaxis (n = 4). Ductoscopy was used to ensure that the OCT catheter was safely inserted through the nipple orifice of the ex vivo specimens. Cross-sectional OCT scanning of the ductal epithelial layers was performed to acquire high-resolution images of approximately one million pixels. The abnormal lesions identified on the OCT images were evaluated using correlating histopathologic analyses. Results: Fourteen out of 18 mastectomy specimens could be cannulated and distended using ductoscopic instruments and saline. Only 4 out of 18 specimens had presented with clinical PND. To confirm that the ductoscopic trocars were located inside the ducts, 14 specimens were randomly selected and explored with ductoscopy. The OCT catheter was able to insert through the ductoscopic trocars in 10 specimens and revealed one in situ ductal cancer (DCIS) in a cancer-involved specimen and one florid ductal hyperplasia in a prophylactic specimen. Both lesions were confirmed by histopathological correlations. The OCT scanning did not detect malignant lesions in 80% of the specimens without PND; however, the OCT scanning did detect microcalcifications and undefined lesions. Conclusion: This is the first published study to confirm the feasibility of intraductal breast OCT to show millimetric Florid Ductal Hyperplasia and a DCIS in a prophylactic and cancer involved specimen, respectively.