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Purpose

To describe and verify sonography-guided Mammotome vacuum-assisted breast biopsy as a better surgical intervention for treating patients with pathological nipple discharge.

Methods

Initial clinical evaluation has been conducted via a thorough medical history inquiry and appropriate physical examination followed by imaging diagnostic modalities of sonography  and ductoscopy for benign diseases exploration as the preliminary clinical diagnosis outcome. Patients diagnosed as benign diseases in Breast Imaging-Reporting and Data system at level 0-III have been enclosed into the study group. Eventually, the final 38 cases of patients with pathological nipple discharge were collected from May 2019 to January 2022 at Beijing Friendship Hospital, Capital Medical University, and randomly divided equally into a control group of 19 cases in the surgical treatment by conventional open excision in parallel to the experimental group of 19 cases in the surgical intervention of sonography-guided Mammotome vacuum-assisted breast biopsy. Control, surveillance, and prevention of hospital-associated infections have been included in all routine surgical procedures. Breast questionnaire module has been introduced to collect the data on patients' satisfaction scores as the follow-up survey. 

Results

A selection of 38 cases of patients with pathological nipple discharge had qualified according to the inclusion criteria. Diagnoses of all patients’ cases had been benign lesions categorized at level 0-III in Breast Imaging-Reporting and Data System. Selected factors of operational duration, incision length, and breast questionnaire scores had differences of statistical significance. Sonography-guided Mammotome vacuum-assisted breast biopsy had slightly more complicated operational issues than conventional open excision (P<0.05). On incision length, sonography-guide Mammotome vacuum-assisted breast biopsy had been superior to conventional open excision with minor skin damage (P <0.01). A follow-up survey of breast questionnaire on patients' fulfilment in the perioperative period had indicated that sonography-guided Mammotome vacuum-assisted breast biopsy scores had been higher than conventional open excision (P<0.01).

Conclusion

 Both surgical techniques had been successful in the treatment of patients with pathological nipple discharge. The surgical technique of sonography-guided Mammotome vacuum-assisted breast biopsy - compared to conventional open excision - had apparent advantages in terms of better therapeutic effect and aesthetic desirability in appearance compared to conventional open excision. Although it had required a little longer operational duration, the merits of quick postoperative wound recovery and fewer risks of complications had outweighted by more excellent satisfaction from patients.

Popular scientific summary

Pathological nipple discharge (PND) is a third complaint following breast pain and breast mass. It particularly affects females between 30-50 years old. Majority incurring etiologies are benign diseases but still associated with malignant occurrences. Regularly PND is characterized by color-stained, serous-like, and sanguineous secretion, unilaterally, spontaneously, and persistently or intermittently, compared to physiological discharge with typical regular milk or colostrum lactation. Since the PND clinical manifestations are discernible apparently, history inquiry and physical examination are essential introductory steps in clinical evaluation. Subsequently, screening the benign diseases and defining the types of diseases are assisted by diagnostic imaging techniques of sonography and ductoscopy during clinical evaluation phases, respectively. These essential methodological procedures are explicitly interpreted by subcutaneous imaging observation to select the benign diseases rated in BI-RADS®ACR (Breast Imaging-Reporting and Data System, American College of Radiology) at level 0-III, and the nature of diseases can be identified by intraductal exploration. This radiological ultrasound is a routine examination method with notable merits of being less invasive compared to ductoscopy and free from ionizing radiation. Sonography can be conducted in two operational modes, brightness-mode ultrasound (B-ultrasound) and contrast-enhanced ultrasound (CEUS). The main difference being how two corresponding ultrasonic probes are applied and administered in two manners with the coupling agents - the former is applied directly to scribble on the skin of the affected breast, and the latter is injected intravenously. This discrepancy has resulted in different systematic images and subsequent clinical appraisals. The fiberoptic ductoscopy is typically an invasive technique cannulated in PND-affected nipple orifice. The apparent advantages have resulted in its popularity. The cannulated microendoscope can directly provide real-time observation, exploration, and intraductal lesion localization. While the final nature of breast disease should refer to the confirmation of postoperative histopathology. This project's compiled patients within the inclusion criteria have validated the diagnosis of four main etiologies. Intraductal papilloma is deemed a benign lesion accounting for 30% to 40% of patients with PND and ductal ectasia occupies 15% to 30%. Other etiology circled around breast fibroadenoma. Fibrocystic changes in epithelial and mesenchymal tissues are mainly incurred by drug abuse, such as oral contraceptive pills. Epithelial hyperplasia likewise exists. Atypical traits commonly arise due to hyperplasia, namely atypical hyperplasia, which has a higher risk correlated with canceration. Therefore, adequate measures must be taken for treating patients to fulfill the purpose of the radical cure while operational excision is the primary clinical treatment. Each of the 38 patients are divided randomly and evenly into one of two study groups treated with two disparate surgical methods: conventional open excision (COE) and sonography-guided Mammotome vacuum-assisted breast biopsy (VABB). Briefly, COE is a traditional surgical method with a series of routine surgical devices to open a large wound on the breast by exposing the percutaneous lesions for removal and resection. In contrast, sonography-guided Mammotome VABB has applied minimally invasive techniques for breast gland surgery. With the advent of vacuum-assisted breast biopsy by Mammotome equipment, opening a tiny and barely visible incision becomes a reality and close to perfection via gaining the subcutaneous visualization of breast mass under the guidance of real-time monitoring by sonography. Expectations and significance have reached fulfillment in this project thesis dedicated to securing and substantiating that sonography-guided VABB has prevailed in treating patients with PND. It not only can advance the development of minimally invasive techniques applied in breast surgery as a novel diagnosis and therapy manner for patients with PND but also can actualize and reflect the humanized concept of a modern medicine model.