A second ductoscopy procedure in patients with recurrent and persistent pathological nipple discharge

Background: Most patients suffering from pathological nipple discharge (PND) undergo local surgical procedures because standard radiologic imaging often fails to reveal the cause. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization and can avoid unnecessary diagnostic surgical procedures. Hence, patients with recurrent or persistent PND after an unsuccessful ductoscopy procedure still undergo unnecessary surgery. This study describes the experience of a second ductoscopy procedure in patients with recurrent or persistent PND without suspicious radiological findings. Methods: Patients with recurrent or persistent PND who underwent two ductoscopy procedures between 2010 and 2017 were retrospectively analyzed. The second ductoscopy was performed when the first ductoscopic attempt was unsuccessful due to technical problems. The primary outcome was the number of prevented surgical procedures.Results: A total of seventeen patients underwent two ductoscopy procedures. The first ductoscopy showed a polypoid lesion in ten patients (58.8%), no abnormalities in three patients (17.6%), and in four patients (23.5%), it was not possible to visualize the ductal tree. Post-procedure, all patients suffered from PND. After two ductoscopic attempts, PND stopped in ten patients (58.8%), and seven patients (41.2%) still suffered from PND and were operated on. Pathology of the resection specimens showed no abnormalities in one patient, a papilloma in five patients, and DCIS in one patient.Conclusion: A second ductoscopy procedure can be considered in the diagnostic work-up of patients suffering from persistent or recurrent PND after an unsuccessful first ductoscopic attempt to avoid unnecessary surgery in about 59% of the cases.