Ductoscopy, lavage combo promising. (Breast Evaluation).

SAN ANTONIO -- Mammary ductoscopy may provide the missing link that renders ductal lavage more clinically relevant, Dr. Seema A. Khan said at the annual breast cancer symposium sponsored by the San Antonio Cancer Institute.

The finding of cytologic atypia on lavage indicates that something abnormal is going on but provides no information about precisely where within the sampled duct the abnormality is located, or even if a definable lesion is present. That's where ductoscopy shows great promise, said Dr. Khan, a surgeon at Northwestern University in Chicago.

To perform ductoscopy, the physician inserts a rigid endoscope into the duct and directly visualizes the duct lining. The idea is that the operator will often be able to tell whether a lesion, if present, is worrisome and warrants surgical excision. If so, ductoscopy can delineate the extent of disease and direct surgery such that the entire affected area can be removed with a smaller specimen than would otherwise be taken, often preserving duct function. And if no pathology is seen on ductoscopy, perhaps the patient may safely avoid surgery altogether.

There are as yet no published data on the use of lavage in combination with ductoscopy although this is under active study at a number of institutions. In one recent success story, a 62-year-old woman at Northwestern who was at high risk for breast cancer underwent ductal lavage, which yielded cellular atypia. Next came ductoscopy, which showed the precise location of a white nodular lesion of ductal carcinoma in situ. Excision of the duct yielded a 9-mm grade 3 carcinoma in situ.

"We have one other patient like this, and many other institutions have anecdotes along the same lines. But to define this further; it will most ...