Mammary ductoscopy: current status and future

Background. Mammary ductoscopy (MD) allows direct visualisation of the mammary ducts using sub-millimetre fiberoptic microendoscopes inserted through the ductal opening onto the nipple surface. The sharp clear magnified images are viewed on a video monitor. Such scopes have working channels that allow irrigation and ductal lavage for cytological analysis. MD can be performed under local anaesthesia in the office setting. This article reviews the evolving role of MD in the diagnosis and treatment of intraductal breast disease. Methods. A literature search was carried out from Pubmed for indexed articles published over the last 30 years using the keywords 'mammary ductoscopy' and 'breast ductoscopy'. Results. The search yielded 27 indexed published articles and reports. Important major reports and studies were reviewed, screened and tracked for other relevant publications. The most important articles were analysed and discussed. The review also includes our published and unpublished original work in the field of MD. Conclusions. MD is a useful diagnostic adjunct in patients with pathological nipple discharge (PND). Furthermore, it can reduce the number and extent of duct excision operations for PND. However, its potential use in the early detection of breast cancer, guiding breast conserving surgery (BCS) for cancer, therapeutic ablation of intraductal disease, and guiding risk-reducing strategies among high risk women requires further research and evaluation. Future developments include the development of a biopsy kit, combining MD with molecular diagnostic markers and real-time optical biopsy system for the diagnosis of pre-malignant and early malignant disease and radiofrequency for curative ablation of intraductal lesions. q 2004 Published by Elsevier Ltd.