Intraoperative localization of occult colorectal tumors during laparoscopic surgery by magnetic ring markers-a pilot study.

PURPOSE: Intraoperative localization of small tumors or malignant polyps has been an important issue in laparoscopic colon surgery. We have developed a new method for preoperative endoscopic tumor marking using a ring-shaped magnetic marker. METHODS: In a pilot study, 28 patients with small colonic (n = 23) or rectal tumors (n = 5) underwent endoscopic magnetic clipping prior to laparoscopic resection. A cap carrying a high-power neodymium ring magnet was mounted on the tip of a colonoscope. Near the lesion, the ring magnet was released and clipped to the colorectal wall. Standard laparoscopic instruments were used to find the magnet intraoperatively. RESULTS: Endoscopic fixation of a ring magnet next to the tumor by clipping was technically feasible in all 28 patients. Intraoperative localization of the marked lesions was successful in 27 of 28 patients (96 %). All patients underwent magnet-guided radical laparoscopic resection of the tumor with an average proximal and distal resection margin of 101 and 63 mm, respectively. In one case, the magnet could not be found due to preoperative migration. Surgical complications related to magnetic clip application or intraoperative tumor localization were not observed. However, there was one case with an intraoperative perforation of the colon by the magnet, which was obviously caused by unchecked action with a laparoscopic instrument. CONCLUSIONS: Preoperative endoscopic labeling of colonic lesions with on-the-scope magnetic markers is simple and safe. Intraoperative tumor localization during laparoscopic colorectal surgery can be achieved reliably without additional equipment such as ultrasound or fluoroscopy.

Intraoperative ductoscopy in women undergoing surgery for breast cancer.

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.

Gradient index ductoscopy and intraductal biopsy of intraductal breast lesions.

OBJECTIVE: Breast duct endoscopy is increasingly used for evaluation of intraductal disease. We have investigated a new rigid instrument for ductoscopy and intraductal biopsy of pathologic lesions. METHODS: From 2002 to 2006, ductoscopy was performed in 111 women with breast cancer or pathologic nipple discharge. A rigid gradient index microendoscope (diameter .7 mm) was used for all examinations in combination with a specially developed needle for intraductal vacuum-assisted biopsy. Ductoscopy and intraductal biopsy were correlated with ductal cytology and histopathology of the resection specimen. RESULTS: Ductoscopy identified intraductal lesions in 41% of the patients with breast cancer presenting as red patches, microcalcifications, or ductal obstruction. Compared with patients with a normal ductoscopy, patients with pathologic ductoscopy had a significantly higher risk of extensive intraductal carcinoma (71% versus 16%, P < .05). Ductal cytology showed only a few cases with severe cytologic atypia or malignant cells in cases with ductoscopic abnormalities. Intraductal vacuum-assisted biopsy yielded diagnostic material in 89% of 36 patients with nipple discharge and papillomatous lesions. Histology of the resection specimen confirmed the diagnosis in all cases (26 papillomas, 2 in situ carcinomas, and 2 invasive ductal carcinomas). In contrast, ductal cytology showed only moderate correlation with histopathology. CONCLUSIONS: Ductoscopy is a useful supplement for the standard radiological workup of breast cancer especially in patients with extensive intraductal carcinoma. Ductoscopic vacuum-assisted biopsy is a new and effective technique for intraductal biopsy under visual control.

Ductoscopy and intraductal vacuum assisted biopsy in women with pathologic nipple discharge.

BACKGROUND: Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors. METHODS: From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen RESULTS: Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ. CONCLUSIONS: Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.