Abstract:

Objective

To evaluate the value of intraductal aspiration ThinPrep Cytology Test (TCT) by fiberoptic ductoscopy (FDS) in the diagosis of nipple discharge.

Methods

FDS,intraductal aspiration TCT by FDS were used to diagnose and examine 107 patients with confused nipple discharge during April 2004 to June 2006; 79 patients were treated operatively. The results of diagnosis and biopsy pathology were studied.

Results

Using FDS 107 patients with nipple discharge were diagnosed. 77 were detected to have intraductal tumor, and 88.3% was below the third branch duct. The over accuracy of FDS and TCT was 74.7% and 81.0%. The accuracy of FDS and TCT was 86.7% and 76.7% over the second branch duct. But the first branch duct and the second branch duct accounted for 67.3% and 83.7%. The accuracy, sensitivity and specificity were 60.3%, 81.4% and 77.8% for intraductal papillomas, and those of TCT were 84.2%,7 4.4% and 83.3% , respectively.And their Likelihood ratio of a positive test (LR) was 3.67 and 4.46, that of FDS for breast cancer was 66.7%,31.6% and 78.3%, and that of TCT was 100%, 68.4% and 90%, respectively. FDS and TCT were used together to diagnose breast cancer , and the sensitivity and specificity were improved to 84.2% and 96.7%. And their LR was 1.46 and 6.84, LR of combined use of the two means to diagnose breast cancer reached 25.5.

Conclusions

FDS is a good method to diagnose nipple discharge of the first branch and the second branch. But for the third branch, combine use of FDS with TCT can improve the accuracy and decrease false-negative rate of nipple discharge. It is helpful in differentiating malgnant from benign discharge.

Key words: Nipple discharge, Endoscopy, Cytology, Diagnosis