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Routine Operative Breast Endoscopy During Lumpectomy

From the University of Oklahoma Breast Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Correspondence: Address correspondence and reprint requests to: William C. Dooley, MD, University of Oklahoma Breast Institute, 825 N.E. 10th Street, Suite 3500, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; Fax: 405-271-3495; E-mail: wcdooley{at}cox.net

Background: Lumpectomy for the management of breast cancer is commonly directed by mammography or ultrasound. We hypothesized that fluid-producing ducts would likely connect to the site of the known cancerous or precancerous lesion and that endoscopic evaluation might reveal unsuspected additional disease.

Methods: All women undergoing lumpectomy in a single surgeon’s practice from January 2000 to August 2001 were evaluated for fluid production from the nipple at the time of lumpectomy. All fluid-producing ducts were cannulated and endoscoped with a 0.9-mm Acueity microendoscope.

Results: Of the 201 patients (16 with atypical ductal hyperplasia, 52 with ductal carcinoma-in-situ, and 133 with stage 1 or 2 breast cancers), 150 (74.6%) could be successfully dilated and scoped. Additional lesions outside the anticipated lumpectomy were identified in 41% (n = 83) of cases. If successful, the chances for a positive margin for cancer decreased from 23.5% to only 5.0%. Endoscopy proved to be a useful adjunct in this series of patients because it identified all cases of extensive intraductal component in early-stage breast cancer.

Conclusions: Routine operative breast endoscopy can reduce the need for re-excision lumpectomy. It also finds substantially more cancerous and precancerous disease than anticipated by routine preoperative mammography and ultrasound.

Key Words: Breast carcinoma • Breast ductoscopy • Breast endoscopy • Breast conservation

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