Ductoscopy,
also referred to as mammary endoscopy, involves inserting a small
fiber-optic scope into the ductal openings of the nipple to look at the
lining of the ductal system on amonitor or screen. This provides a
window into the ductal system to help identify abnormalities.
Oftentimes, cells can be collected after the duct has been
visualizedwith ductal lavage.
With the development of newer and more usable ductoscopes, ductoscopy
is now easily performed in the operating room or the outpatient
setting.
Who Should Have Ductoscopy?
Although ductoscopy is available in many breast centers,
it is not designed to beused as a risk assessment tool. Most often,
ductoscopy is performed on a woman who is experiencing a spontaneous
nipple discharge that is either bloody or clear and thick, like mucus. You can learn more about the types of nipple discharge that you need to be concerned about here.
A
thick or bloody discharge is often caused by an intraductal papilloma,
a smallwart-like growth on the lining of the duct. These growths are
benign but shouldbe removed. On rare occasions the discharge can be the
result of a precancerous condition called ductal carcinoma in situ
(DCIS). But this really is rare. Only4 percent of spontaneous bloody
nipple discharge is found to be related to breast cancer. Even so, it
is important and necessary to have the discharge examined by your
physician.
How Is Ductoscopy Performed During Surgery?
Ductoscopy
is often performed in the operating room as part of the surgical
procedure to identify, remove, and treat the cause of the discharge. By
inserting the scope into the ductal orifice with the discharge, the
clinician is able to see the abnormality causing the discharge and
identify the best place to make a surgical incision to remove the
papilloma.
How Is the Procedure Done in the Outpatient Setting?
Ductoscopy takes a relatively short period of time to perform and
causes minimaldiscomfort. Typically, when done in the outpatient
setting, a numbing cream isapplied to the nipple anywhere from 30
minutes to 2 hours prior to the procedure.The nipple is then cleaned
and made numb with a local anesthetic. A small probeis inserted into
the duct that will be examined to dilate the ductal opening.Then, the
scope is put inside the duct. Once the scope is inside the ductal
system, it can be visualized on a monitor that is connected to the
scope.
Are There SideEffects?
Once the
procedure is complete, the scope is removed. Some patients report some
pain in the nipple or at the surface of the nipple. Others report a
feeling of fullness or pressure in the breast, which usually subsides
in less than two days. There are generally no lasting after effects of
the ductoscopy procedure.
Who Performs Ductoscopy?
Most often, surgeons will perform ductoscopy.
Does Insurance Pay for Ductoscopy?
Most
insurance companies cover ductoscopy. In addition, some centers that
are performing clinical trials may have funding to cover the cost of
ductoscopy within the research setting.
Is Ductoscopy Currently Being Studied?
Ductoscopy
holds a great deal of promise, and is currently the focus of a number
of research trials. Some studies now underway are exploring whether
using ductoscopy during a lumpectomy can help ensure that the
surgicalmargins surrounding the tumor are free of cancerous cells.
Other researchers are looking at the benefit of using ductoscopy if
atypical cells are found in the fluid obtained during ductal lavage to find and potentially remove the abnormality.
How Do I Find a Center Performing Ductoscopy?
You can find a list of many of the centers in the US that offer ductoscopy here.
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