Intraoperative ductoscopy in women undergoing surgery for breast cancer.

ABSTRACT

BACKGROUND: Extensive intraductal disease represents an important clinical problem in the management of patients with invasive or in situ breast cancer. The purpose of this study was to determine the value of intraoperative ductoscopy for detection of intraductal neoplasia in women with breast cancer. METHODS: Intraoperative ductoscopy was performed in 54 women undergoing operation for breast cancer. A rigid gradient index microendoscope (0.7 mm) was used for all examinations. Ductoscopy findings were documented prospectively and correlated with preoperative mammography and histology of the resection specimen. RESULTS: Fifty of 54 (92%) patients were examined successfully. Ductoscopy identified intraductal lesions (ie, red patches, ductal obstruction, or microcalcifications) in 25 of 50 (50%) patients. Abnormal ductoscopic appearance was found in 19 of 23 patients with extensive intraductal disease (82%). Mammographic microcalcifications were observed in 15 of those 19 patients and in 3 patients with normal ductoscopy (78%). The combined sensitivity of both methods was 95%. Patients with an abnormal ductal appearance on ductoscopy, compared with those with a normal ductal appearance, had a greater incidence of extensive intraductal spread of cancer (76% vs 16%) and a greater incidence of positive surgical margins (44% vs 12%). CONCLUSIONS: High-resolution ductoscopy is able to detect extensive intraductal disease in a considerable number of women with breast cancer. In selected patients, a combination of both preoperative imaging and intraoperative ductoscopy may help to avoid incomplete resections and re-excisions.