Many women associate the development of breast cancer with the presence of a lump in their breast. However, another sign that may indicate the existence of breast cancer is spontaneous fluid discharge from the nipple. A new diagnostic technique, called fiberoptic ductoscopy (FDS) may offer a safe and effective alternative to standard diagnostic procedures in women with spontaneous nipple discharge. Results from a recent article published in the journal Cancer indicate the accuracy of this new procedure in determining the presence and diagnosis of abnormal cells within the breast. Diagnoses resulting from this procedure may spare women from unnecessary surgery or assist in defining the type and extent of surgery needed to remove abnormal breast tissue.

The majority of breast cancers start in the lining of a milk duct within the breast. Each breast contains 6 to 9 milk ducts, which are small hollow tubes connecting the milk producing gland to the nipple. One sign of breast cancer, or pre-cancerous conditions, is the spontaneous discharge of fluid from the nipple. Although the majority of women experiencing nipple discharge have non-cancerous (benign) conditions, diagnostic procedures to determine the cause of nipple discharge are usually performed without delay. A common cause of nipple discharge is benign masses of abnormal cells in the lining of a milk duct, called papillomas. Papillomas may eventually develop into cancer, so surgical removal of the masses is standard treatment.

Fiberoptic ductoscopy is an emerging technique that allows a physician to directly visualize the inside of a milk duct to locate the presence of abnormal cells. The procedure works as follows: the physician determines which milk duct is producing the fluid discharge. A very small flexible tube containing a video camera is then inserted into this duct, creating a live picture of the inside lining of the duct. This picture is continually displayed on a television screen, so the physician can perform the entire procedure by watching the screen. A solution of saltwater (saline) is placed into the duct to ensure the duct is patent (open) prior to advancement of the tube. The physician is then able to visualize the lining of the duct, measuring and noting the presence of any abnormal cellular masses. After the physician has visually examined the duct, the saline solution is retrieved. Within the saline solution are exfoliated cells from the lining of the milk duct. These cells are inspected under a microscope to determine the existence of abnormal cells and/or define precise abnormalities. A diagnosis is made according to these cellular abnormalities.

In a recent clinical study, the accuracy of FDS in diagnosing abnormal cells within a milk duct was evaluated. Two hundred fifty-nine women who were experiencing spontaneous nipple discharge underwent the procedure of FDS. Following the procedure, the women underwent surgery to remove any abnormal cellular masses found. The results from the surgical procedure were directly compared to results derived from the FDS. Almost 90% of patients who were found to have abnormal cells from FDS screening showed an equivalent association following inspection of surgical specimens. However, 18% of patients who showed no evidence of abnormal masses from FDS screening that underwent surgery showed positive results for the presence of papillomas. The majority of these papillomas were found in duct branches that were too small for the fiberoptic tube to pass through.

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These results indicate the effectiveness of FDS in accurately determining the presence and location of abnormal cellular masses within medium to large milk ducts. The outcome of FDS screening may effectively dictate the location and extent of surgery needed for women with papillomas or breast cancer or may spare women from unnecessary surgery. Women with spontaneous nipple discharge may wish to speak with their physician about the risks and benefits regarding FDS or about the participation in a clinical trial comparing FDS to standard diagnostic procedures. Two sources of information on ongoing clinical trials include the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. (Cancer, Vol 89, No 7, pp 1512-1519, 2000)

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