Ductoscopy is a modern examination procedure that allows the milk ducts in women’s breasts to be mirrored from the inside. The main indication for this form of diagnostics is the secretion of unclear, mainly reddish fluids from the nipple. By assessing the respective milk duct, it is possible to detect even small changes with the help of ductoscopy and thus to detect both benign lumps and malignant neoplasms at an early stage.
What is ductoscopy?
Ductoscopy is a modern examination procedure that allows the milk ducts in women’s breasts to be mirrored from the inside. Ductoscopy is also known as milk duct endoscopy or galactoscopy. It is one of the endoscopic examination methods, as the diagnosis is made through images taken with the help of a very thin endoscope from inside the body, in this case directly from the milk ducts of the female breast. The ability of a tiny camera to provide meaningful images from the milk duct system means that ductoscopy, as a minimally invasive diagnostic method, can in many cases replace the open biopsy associated with general anesthesia. The images from the milk duct can be followed by the physician simultaneously on the monitor. On the one hand, this provides the opportunity to take a close look at any suspicious areas, and on the other hand, the constant visual control effectively minimizes the risk of complications or injuries. Important: Galactoscopy as a reflection of the milk ducts must not be confused with galactography, in which the female milk ducts are depicted in an X-ray with the aid of contrast medium in addition to a mammogram.
Function, effect, and goals
The main application for ductoscopy is the discharge of a bloody secretion from the female nipple for which there is no conclusive explanation. This may occur from both breasts or unilaterally. Some secretions occur quite spontaneously, while others are triggered only by pressure. Important for the indication for milk ductoscopy is the absence of an obvious cause, which – often especially in the case of clear or milky fluids – may be hormonal (for example, during pregnancy) or determined by the use of certain medications. The minimally invasive procedure is usually used only when the classic imaging procedures such as sonography or mammography have either revealed nothing, or an initial imaging finding that requires further clarification. A nipple swab to detect possible pathogens is also often performed in advance. Every galactoscopy begins with a gentle anesthetic, which can also be a local anesthetic for this examination. With the help of pressure, an attempt is made to provoke the leakage of fluid in order to better locate the affected milk duct. The very fine endoscope with its camera is then inserted into this duct. For a better view, the examiner slightly dilates the milk duct and rinses it with a physiological and thus well-tolerated saline solution. In this way, even the smallest lesions in the milk duct can be easily seen and the physician can navigate through the branched system of milk ducts to where the triggering cause is located with the help of the screen control. In the case of visually unclear findings, a smear or puncture can be taken in the same step so that the material obtained can then be examined pathologically. If it becomes apparent during the examination that the patient requires surgery due to the present findings, the affected milk duct can also be marked immediately during the galactiscopy. This is usually done with a small wire, which is not only easy to find during the surgical procedure, but can also be seen in other imaging procedures, thus marking the diseased area. A common finding that leads to the use of ductoscopy is papilloma of the milk ducts. DCIS (ductal carcinoma in situ) is already a precancerous lesion and thus requires treatment. In this case, pathological cell changes are already evident, but have not yet spread invasively into the tissue outside the milk ducts. With the aid of ductoscopy, DCIS can also be detected at an early stage and has a good prognosis if treated promptly.
Risks, side effects and dangers
Especially compared to the surgical alternative – open biopsy – ductoscopy is a very low-risk procedure. As with any endoscopic examination, there is a small risk of injuring tissue and causing bleeding in the milk duct area. However, this small risk is disproportionate to the benefit that the examination can provide, especially with regard to the early detection of a precancerous lesion. Complications can be avoided in most cases due to the constant visual control of the endoscope’s position via the monitor, the good visibility provided by the saline irrigation, and the maneuverability of the semi-flexible device. Unlike mammography and the sometimes associated galactography, only camera images are taken during milk duct endoscopy. X-ray radiation is not used. In addition, compared to galactography, there is also no need to inject a contrast agent into the milk duct, making ductoscopy suitable even for patients who are sometimes allergic to such agents. The anesthesia chosen – general or local – is associated with the general risks that apply to any procedure, but these are rare and can usually be managed well. Another very gentle alternative to endoscopy is ductosonography, in which ultrasound images are brought directly from inside the milk duct in question to the physician’s monitor, and any constrictions that are detected can already be examined in more detail.
