文档介绍：Minimally Invasive Operation for
Breast Cancer
Ductoscopy
Development of Ductoscopy Technology
The glandular tissue of the breast consists of milk-secreting, lobular
units connected to the nipple by multiple major and minor ducts. Most
breast cancers form initially in the lining of the milk ducts or lobules.
Ductoscopy of the breast uses a fiberoptic endoscope to examine the distal
mammary ducts visually. The initial versions of these endoscopes were
developed as delicate, single-fiber instruments and used for the investi-
gation of pathologic nipple discharge by Okazaki and colleagues in
Sapporo, Japan. A landmark report in 1991 demonstrated in a small series
that both benign and malignant lesions of the ductal lining could be seen
and diagnosed accurately by appearance
The technology was limited by 2 major issues. First, the endoscope
design offered no working port through which insufflation or distension
of the duct could occur, and second, the single fiber was easily broken,
rendering the endoscope useless after only a few cases. The significant
expense of single-fiber endoscopes was a major limitation to the expan-
sion of this technology.
Despite these barriers, a nucleus of Asian investigators continued efforts
to refine and improve the technology during the next -11 This led
to the addition of an insufflation port used primarily to instill air into the
ducts, the development of less-cumbersome camera attachments, and
eventually, the manufacture of lower-cost, multifiber endoscopes. The use
of breast ductoscopy has remained largely concentrated in a few centers
in Asia, where numerous large, clinical trials have been reported, and the
use of ductoscopy to aid the breast surgeon intraoperatively has e
the standard at several centers.
Growing American interest in ductoscopy in the mid-1990s resulted in
a pilot study by Love and Barsky,12 in which single-fiber, submillimeter
endoscopes were used to identify ductal carcin