INTEND II randomized clinical trial of intraoperative duct endoscopy in pathological nipple discharge. BJS 2018; 105: 1583-1590.
Published: 20th September 2018
Authors: G. Gui, A. Agusti, D. Twelves, S. Tang, M. Kabir, C. Montgomery et al.
The majority of lesions resulting in pathological nipple discharge are benign. Conventional surgery is undirected and targeting the causative lesion by duct endoscopy may enable more accurate surgery with fewer complications.
Patients requiring microdochectomy and/or major duct excision were randomized to duct endoscopy or no duct endoscopy before surgery. Primary endpoints were successful visualization of the pathological lesion in patients randomized to duct endoscopy, and a comparison of the causative pathology between the two groups. The secondary endpoint was to compare the specimen size between groups.
A total of 68 breasts were studied in 66 patients; there were 31 breasts in the duct endoscopy group and 37 in the no‐endoscopy group. Median age was 49 (range 19–81) years. Follow‐up was 5·4 (i.q.r. 3·3–8·9) years in the duct endoscopy group and 5·7 (3·1–9·0) years in no‐endoscopy group. Duct endoscopy had a sensitivity of 80 (95 per cent c.i. 52 to 96) per cent, specificity of 71 (44 to 90) per cent, positive predictive value of 71 (44 to 90) per cent and negative predictive value of 80 (52 to 96) per cent in identifying any lesion. There was no difference in causative pathology between the groups. Median volume of the surgical resection specimen did not differ between groups.
Diagnostic duct endoscopy is useful for identifying causative lesions of nipple discharge. Duct endoscopy did not influence the pathological yield of benign or malignant diagnoses nor surgical resection volumes. Registered as INTEND II in CancerHelp UK clinical trials database (
You may also be interested in
Authors: Y. Grant, R. Al‐Khudairi, E. St John, M. Barschkett, D. Cunningham, R. Al‐Mufti et al.
Notes: Reoperations expensive
Meta‐analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy‐proven node‐positive breast cancer. BJS 2018; 105: 1541-1552.
Authors: S. R. Tee, L. A. Devane, D. Evoy, J. Rothwell, J. Geraghty, R. S. Prichard et al.
Notes: In selected patients using dual tracer
Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer‐related lymphoedema. BJS 2019; 106: 100-110.
Authors: A. A. Khan, I. Hernan, J. A. Adamthwaite, K. W. D. Ramsey
Notes: Effective in selected patients
Aesthetic outcome following breast‐conserving surgery assessed by three evaluation modalities in relation to health‐related quality of life. BJS 2019; 106: 90-99.
Authors: C. Dahlbäck, A. Ringberg, J. Manjer
Notes: Better methods needed
Current practice and short‐term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study. BJS 2018; 105: 1778-1792.
Authors: R. L. O'Connell, E. Baker, A. Trickey, T. Rattay, L. Whisker, R. D. Macmillan et al.
Notes: Reduces mastectomy rates
Nationwide population‐based study of trends and regional variation in breast‐conserving treatment for breast cancer. BJS 2018; 105: 1768-1777.
Authors: M. C. van Maaren, L. J. A. Strobbe, L. B. Koppert, P. M. P. Poortmans, S. Siesling
Notes: Regional differences remain
Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap. BJS 2018; 105: 1446-1453.
Authors: A. Svee, M. Mani, K. Sandquist, T. Audolfsson, Y. Folkvaljon, A. E. Isern et al.
Best‐practice care pathway for improving management of mastitis and breast abscess. BJS 2018; 105: 1615-1622.
Authors: N. Patani, F. MacAskill, S. Eshelby, A. Omar, A. Kaura, K. Contractor et al.
Notes: Outcomes improve
Meta‐analysis of the diagnostic accuracy of ultrasound‐guided fine‐needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis. BJS 2018; 105: 1244-1253.
Authors: I. Balasubramanian, C. A. Fleming, M. A. Corrigan, H. P. Redmond, M. J. Kerin, A. J. Lowery et al.
Notes: Core needle biopsy better
Meta‐analysis of the cumulative risk of endometrial malignancy and systematic review of endometrial surveillance in extended tamoxifen therapy. BJS 2018; 105: 1098-1106.
Authors: C. A. Fleming, H. M. Heneghan, D. O'Brien, D. P. McCartan, E. W. McDermott, R. S. Prichard et al.
Notes: Counselling of patients important
Breast‐conserving surgery followed by whole‐breast irradiation offers survival benefits over mastectomy without irradiation. BJS 2018; 105: 1607-1614.
Authors: J. de Boniface, J. Frisell, L. Bergkvist, Y. Andersson
Notes: Radiotherapy to lower axilla key?
Is axillary ultrasound imaging necessary for all patients with breast cancer?. BJS 2018; 105: 930-932.
Authors: M. Ahmed, M. Douek