Percutaneous microductectomy with a directional vacuum-assisted system guided by ultrasonography for the treatment of breast discharge: experience in 63 cases.

BACKGROUND: Vacuum-assisted devices are becoming a useful tool in the diagnosis and treatment of breast pathology. Recent publications show good results in percutaneous removal of benign lesions. PURPOSE: To discuss our experience in percutaneous excision of ductal lesions with a vacuum-assisted, ultrasound-guided directional system. MATERIAL AND METHODS: From January 2003 to July 2006, 63 patients with pathological nipple discharge and intraductal lesion identifiable on imaging were studied at two reference centers. Percutaneous excision with a vacuum-assisted device was offered as an alternative to surgery. RESULTS: A total of 71 lesions were diagnosed in 63 patients with a mean age of 52 years. All the patients presented nipple discharge. Mammography was normal in 65 cases (92%). Galactography showed an intraductal lesion in 67 cases (94%). Mean lesion size on ultrasonography was 7.4 mm (2-26 mm). Percutaneous excision was performed in 45 lesions (63%), while surgical excision was indicated in 26 lesions. The histopathological results in the 45 lesions biopsied demonstrated intraductal papilloma in 30 cases, dilated duct with papillomatous projections in 11, ductal ectasia with no papillary lesion in three, and a nonspecific benign result in one. Excision was considered complete in 41 lesions (91%). Clinical signs of discharge were resolved in 39 patients (95% of cases treated percutaneously). Mild complications occurred in four cases. CONCLUSION: Percutaneous excision of ductal lesions with an ultrasound-guided, vacuum-assisted device is a safe procedure with high diagnostic and therapeutic value for the management of breast discharge.