How to do breast ductoscopy

Breast ductoscopy is a method of checking for widened breast ducts. It mainly uses an endoscope with a diameter of 0.75mm to detect the breast ducts. The examination will be painful and requires anesthesia. After we insert the breast ductoscope, we can observe the problems with the breast ducts on the computer. If breast duct disease occurs, we need to receive treatment in time. You can learn about its examination results analysis.

Inspection object

Patients with nipple discharge as the primary symptom account for 3% to 14% of breast disease patients, and its incidence is second only to breast lumps and breast pain. Nipple discharge often occurs in breast hyperplasia, intraductal papilloma, breast inflammation, mammary duct ectasia or breast cancer. Bloody nipple discharge is common in intraductal papilloma or breast cancer.

Operating Procedure

Duct endoscopy is a procedure in which an endoscope with a diameter of 0.75mm (0.6mm or 0.95mm) is inserted into the opening of the mammary duct and the end of the mammary duct is probed toward the end while observing the situation inside the mammary duct through a medical monitor. The farthest that can be reached is the fourth or fifth duct branch. The entire examination process takes about 10 to 15 minutes. No local anesthetic injection is required and the patient does not feel any pain or discomfort. The ultrafine duct endoscope is composed of an ultrafine optical fiber image bundle, a light guide, a tiny self-focusing mirror and a lens. Through the ultrafine duct endoscope examination, the condition of the breast duct wall and the ductal secretions can be clearly observed. If there is a space-occupying lesion, its color, size, shape, smoothness, etc. can be described. Breast ductal carcinoma, intraductal papilloma, and ductal inflammation each have their own characteristic ductal endoscopic manifestations, and thus a diagnosis can be made based on this. Another function of the duct endoscope is to perform a biopsy of the lesion under the guidance of the duct endoscope to obtain a pathological diagnosis; to mark the lesion on the skin surface or to accurately locate the surgery by placing a positioning guide wire under the duct endoscope; and to treat benign diseases in the milk duct through the duct endoscope.

Check significance

Abnormal results

1. For patients with various nipple discharges, especially those with bloody or yellow discharges, the incidence of tumorous lesions in the milk ducts is about 1/3 to 1/2. In addition, many patients with white discharges are also caused by tumors in the milk ducts, and all of them need surgical treatment after ductoscopy.

2. Tumors in the areola area with nipple discharge. Most tumors in this area are intraductal tumors or fibroadenomas, which are closely related to the milk ducts. Ductoscopy can identify the diseased milk ducts, thereby guiding the surgery to accurately remove the tumor and the diseased milk ducts, reducing the chance of local recurrence after surgery;

3. Patients with plasma cell mastitis around the areola. Plasma cell mastitis is caused by proximal plugging of the milk duct, accumulation of secretions, desquamated cells, and inflammatory cells in the milk duct, resulting in acute and chronic inflammation of the breast. Ductoscopy can irrigate and collect the exfoliated cells in the milk ducts, perform cytological examinations, and confirm the diagnosis. It can also flush and dredge the diseased milk ducts to achieve the purpose of drainage. In addition, if the inflammation is relatively localized, the diseased milk ducts can be identified under the ductoscopy, and the diseased milk ducts and local scar tissue can be surgically removed.

4. Mastodynia is a type of breast hyperplasia, partly due to the blockage of the proximal milk duct, which makes the distal milk duct difficult to drain and twisted. Milk duct lavage and milk duct dredging under a ductoscope can help to clarify the diagnosis and achieve a certain therapeutic effect.

5. For patients with milk cysts, symptoms can be improved after unblocking the milk ducts.

in short

1. Identify the cause of nipple discharge

2. Refine surgical indications and reduce unnecessary surgeries

3. Reduce the scope of surgery and accurately remove the lesion

4. Exploratory treatment of some special types of diseases

5. Use ductoscopy to perform minimally invasive treatments and surgeries