Ex vivo feasibility study of endoscopic intraductal laser ablation of the breast.
OBJECTIVE
To determine the feasibility and safety of breast endoscopic thulium laser ablation for treatment of intraductal neoplasia.


STUDY DESIGN
Ductoscopy is a minimally invasive endoscopic approach of the milk ducts of the breast via the nipple. Besides diagnosis in women with pathologic nipple discharge (PND), it allows non-invasive removal of intraductal lesions with a stalk like papillomas. Removal, however, is often incomplete and flat lesions cannot be targeted. We therefore developed laser ductoscopy.


METHODS
Dosimetry of laser ductoscopy was assessed in thirteen mastectomy specimens, applying power settings of 1-5 W with 100-1000 ms pulsed exposure to a 375-μm outer diameter thulium fiber laser. Subsequently histology was obtained from the breast tissue that was treated with the Thulium laser.


RESULTS
Endoscopic view was maintained during ductoscopic laser ablation at 1-3 W. Increasing power to 4-5 W caused impaired vision due to shrinkage of the main duct around the ductoscope tip. Histology revealed localized ablation of the duct wall.


CONCLUSION
We show for the first time that laser ductoscopy is technically feasible. The Thulium laser enables a superficial intraductal ablation and is a useful tool for intraductal interventions. An in vivo prospective study is needed to further demonstrate its potential. Lasers Surg. Med. 50:137-142, 2018. © 2017 Wiley Periodicals, Inc.
['de Boorder|Tjeerd|T|', 'Waaijer|Laurien|L|', 'van Diest|Paul J|PJ|', 'Witkamp|Arjen J|AJ|']
D001940:Breast D004724:Endoscopy D005240:Feasibility Studies D005260:Female D006801:Humans D066298:In Vitro Techniques D053685:Laser Therapy D009558:Nipples D013932:Thulium
intraductal ductoscopy nipple discharge breast cancer endoscopy laser treatment