Is ductoscopie bij pathologische tepeluitvloed zinvol gebleken?

Abstract

Pathological nipple discharge (PND) is a common complaint in women and is defined as spontaneous, unilateral (bloody or serous) nipple discharge from a single milk duct. In 5-10% of cases, there is an underlying (pre)malignancy, but in most cases, it is caused by benign intraductal abnormalities located directly behind the nipple. As a result, mammography and ultrasound often show no abnormalities, which necessitates a (diagnostic) surgical procedure. Ductoscopy is a minimally invasive, micro-endoscopic technique that allows the visualization of the milk ducts through the nipple orifice under local anesthetic. This technique was already described in 2013 in the NTvG as a new innovative technique, which makes it possible to diagnose and remove intra-ductal abnormalities and, therefore, is able to effectively select patients who will benefit from a classic operation under general anesthesia. Surgery can be prevented in 2/3 of patients by adding ductoscopy to the work-up in case of PND. Ductoscopy has now been included in the "breast cancer" guideline in The Netherlands.