A Study Of The Value Of Positioning Guide Wire Through Fiberoptic Ductoscopy In The Treatment Of Breast Intraductal Lesions

Objective:To investigate the value of positioning guide wire throughfiberoptic ductoscopy in minimally invasive surgery for patients with nippledischarge and its merits comparing with routine operation.Methods:97cases with the appropriate single-hole nipple dischargediagnosed as corresponding breast intraductal, which were treated withsurgery in the department of Breast Surgery of Dalian Central Hospital fromJune2010to January2012， were analyzed retrospectively. Among the97cases,51cases treated with positioning guide wire through ductoscopy inminimally invasive surgery (experimental group), another46cases ofpatients treated with routine methylene blue staining of segmentalmastectomy(control group).Comparing and evaluating the surgicaloutcomes between the two groups.Results:1.Fiberoptic ductoscopy(FDS)performance(1)Normal mammary ducts： The wall of duct was smooth andshiny,with good elasticity, showed milky white or pale red, capillaries wereclearly visible.(2)Mammary duct ectasia (inflammation): The ducts were unobstuctedand expand, but the wall was less smooth.Milk sinus angle peripheral wallwas roughness and elastic to a lesser extent, rich in capillaries, and touch ofbleeding.Inflammatory mammary ducts performanced as lumen wasirregular, local wall congested extensively, flake bleeding spots wasvisible.The wall was roughness, lost of normal structure.White or dark greyfloc and fiber bridging structure floc could be seen in the ducts.(3)Intraductal Papilloma (disease):papillary tumors found inLaticifers, usually occurred in gradeⅠ-Ⅱ ducts.Mostly single, solitary Papilloma with pedicle, as a mulberry-like or hemispherical protruding intolumen, the surface was smooth, yellow, red, or red and yellow.Papillomacan also be multiple, with the performance of the spherical fusion vary insize.Papilloma disease can always be seen in grade Ⅲ-Ⅳ ducts, being singleor multiple, showing as multiple small spherical or papillary ridges, withwhite wall crests.Or only upstream peripheral catheter was bleeding,withpointlike bleeding around the wall.Lesions following catheter was oftenblocked, without a bridge structure in the lumen.（4）Ductal carcinoma in situ(DCIS): Much were located in the coarseof the main and1branch ducts.Performance as the gray and white or palered irregular superficial uplift with the growth along the ducts, havingwidth base without pedicle.The tumor showed flat, dense small nodules orhemispherical protuberance.DCIS was often bigger than Papilloma withdiameter>2mm.Cancer scattered in flake bleeding, with surface erosion,and pointlike bleeding or showed as acne-like.Lesion always obstructedthe ducts with proximal duct ectasia.2.Comparsion of incision length and sample sizes between theexperimental group and the control groupExperimental group showed surgery incision length as (2.6±0.3) cm,specimens weight average as (11±5.0) g due to the use of guide wirepositioning in the operation; control group showed surgery incision lengthas (3.5±0.5) cm, due to the wedge shaped resection of methylene bluestaining in all mammary ducts and around glands, specimens weight wassignificantly greater than experimental group, for an average of(35±5.9) g.3.Comparsion of the rate of pathologic findingsThis group of97cases was successfully found lesions in mammaryducts and excised.We called the found of intraductal lesions afteroperation as pathological positive.Among the experimentalgroup,postoperative pathology confirmed44patients with IntraductalPapillary (86.3%),2cases with papillary tumor (3.9%),2cases withintraductal Carcinoma of the breast (3.9%),with pathological detection rate94.1%（48/51）, of which3cases of mammary gland diseases.Among thecontrol group, postoperative pathology confirmed28cases of IntraductalPapillary tumor (60.9%),3cases of papillary tumor (6.5%),1case of intraductal Carcinoma of the breast (2.2%), with pathological detection rate69.6%（32/46）,6cases of mammary duct ectasia,8cases of mammarygland.The pathological detection rate of the experimental group wassignificantly higher than the control group (χ2=10.87,P=0.001)(see table4), P<0.054.Comparison of the breast shape and the complication after operationTwo groups of cases had no complications such as infection, effusion, orcracked.8cases of the control group had mild depression of nipples;thebreast shape of experimental group were well.Two groups of patients hadno nipple discharge in the3months of follow-up.Conclusion:1.Comparing with routine operation,FDS with guide wire positioning forintraductal lesions demonstrated its merits of a smaller incision, lessdamage of the glands, better breast shape after surgery and a higherpathological detection rate.2. The fiberoptic ductoscopy demonstrates its superiority in thetreatment of breat intraductal lesions.