Breast ductoscopy: technical development from a diagnostic to an interventional procedure and its future perspective.

BACKGROUND Endoscopy of the female breast, known as ductoscopy, is increasingly gaining acceptance as a diagnostic procedure worldwide. Recent technical development of ductoscopes and micro-instruments is shifting research interest from diagnostic to interventional ductoscopy. We describe novel technical aspects and the resulting possible future perspective of ductoscopy. METHODS This study comprised the analysis and review of new technical developments from research at the Technical University Munich, Germany, and others, as well as a review of the MEDLINE and COCHRANE databases for the keyword ductoscopy. RESULTS Diagnostic ductoscopy is performed by many breast physicians worldwide. Interventional ductoscopy, however, depends on an additional working channel and a variety of micro-instruments of 0.4-0.8 mm for procedures inside the breast duct. They are at present not available in the U.S. but are used in Germany and several other countries. Autofluorescence ductoscopy is a new imaging technique used on an experimental base for clinical evaluation to identify intraductal lesions. Laser ductoscopy for removal of intraductal papillomas and 3-dimensional intraductal tracking systems are future projects. CONCLUSION Technical innovation and further miniaturization of instruments is supporting a change from diagnostic to interventional ductoscopy. A therapeutic intraductal approach as well as autofluorescence endoscopy could potentially eliminate unnecessary biopsies and offer better identification of intraductal lesions.