Routine operative breast endoscopy during lumpectomy

Background: Lumpectomy for the management of breast cancer is commonly directed by mammography or ultrasound. We hypothesized that fluid-producing ducts would likely connect to the site of the known cancerous or precancerous lesion and that endoscopic evaluation might reveal unsuspected additional disease. Methods: All women undergoing lumpectomy in a single surgeon's practice from January 2000 to August 2001 were evaluated for fluid production from the nipple at the time of lumpectomy. All fluid-producing ducts were cannulated and endoscoped with a 0.9-mm Acueity microendoscope. Results: Of the 201 patients (16 with atypical ductal hyperplasia, 52 with ductal carcinoma-in-situ, and 133 with stage I or 2 breast cancers), 150 (74.6%) could be successfully dilated and scoped. Additional lesions outside the anticipated lumpectomy were identified in 41% (n = 83) of cases. If successful, the chances for a positive margin for cancer decreased from 23.5% to only 5.0%. Endoscopy proved to be a useful adjunct in this series of patients because it identified all cases of extensive intraductal component in early-stage breast cancer. Conclusions: Routine operative breast endoscopy can reduce the need for re-excision lumpectomy. It also finds substantially more cancerous and precancerous disease than anticipated by routine preoperative mammography and ultrasound.