Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge

Background. Duct excision for pathologic nipple discharge (PND) often requires "blind" surgical resection. Intraoperative mammary ductoscopy can allow for direct visualization of intraductal abnormalities during surgical resection. Methods. We reviewed our experience with 119 patients with PND undergoing ductoscopy-directed duct excision. The variables that could interfere with a successful procedure were analyzed. Results. Cannulation of the discharging duct was successful in 105 of 119 (88%) of patients, and ductoscopy-directed duct excision could be performed in 104 of 119 (87%). A preoperative ductogram was obtained in 70 patients and was positive in 53 of 70 (76%) In this same group, ductoscopy was positive in 63 of 70 (90%). The pathologic diagnoses were as follows: cancer (5), papilloma (84), and hyperplasia (16), for an abnormal pathology yield of 88%. Hyperplasia and cancer were significant predictors of unsuccessful cannulation. In 22 patients, ductoscopy visualized multiple lesions or abnormalities beyond 4 cm. Conclusions. Mammary ductoscopy for PND is a safe, effective procedure that offers advantages of a high lesion localization rate and intraoperative guidance, therefore, negating the need for a preoperative ductogram. Lesions deep within the ductal system can be identified and removed, which would likely have been missed by blind duct excision.