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Ductoscope Lights up Breast Cancer Diagnosis

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Ductoscope Lights up Breast Cancer Diagnosis April 15, 2007 • www.familypracticenews.com Women’s Health 31 Ductoscope Lights Up Breast Cancer Diagnosis BY MICHELE G. SULLIVAN Diagnostic and autofluorescence ducto- Mid-Atlantic Bureau scopies were performed before segment or duct excision or lumpectomy. The addi- O RLANDO — Light may soon take a tional time required for the ductoscopy place in the diagnostic and surgical arma- was minimal, ranging from 5 to 15 minutes, mentarium for breast cancer. and there were no associated complica- Researchers at the Technical University tions. There was no need for intravenous of Munich have developed and are cur- administration of any contrast agent be- rently evaluating the world’s first autoflu- cause the procedure uses only light. orescence ductoscope, which has the po- The paper notes that areas of suspicion tential to diagnose the earliest forms of reflected light values distinctly different intraductal breast cancer and guide surgi- from those of normal tissue. “The degree cal treatment. of blue-violet color appears to be propor- The instrument combines an autofluo- tional to the degree of alteration in this tis- rescence light source and camera already sue, just as it is in bronchoscopy,” Dr. Ja- approved in Europe for diagnostic bron- cobs said at the meeting sponsored by the choscopy with a 1.3-mm diameter ducto- Society of Laparoendoscopic Surgeons. scope. Like autofluorescence bron- “The more light we see, the more dys- choscopy, it operates on the principle that plastic the tissue should be.” healthy and dysplastic tissues reflect different percentages of light, Dr. Volker R. Jacobs said at a meeting on laparoscopy and minimally invasive surgery. Light-induced fluorescence bronchoscopy has been used for several years to identify ACOBS early lung lesions: A helium R. J cadmium blue laser stimulates the lining of the bronchi to OLKER . V R autofluoresce in a range of col- D ors. Normal, healthy tissue is shown as being bright green, OURTESY and suspicious tissue looks C reddish-brown. A summary of Dr. Volker R. Jacobs is shown with a display of images studies with this technique obtained on his prototype autofluorescent ductoscopy. concluded that it can increase the detection rate of premalignant lesions This observation, if confirmed in by up to six times, compared with con- prospective trials, could “lead us to be ventional, white-light bronchoscopy (Lung able to intraoperatively differentiate be- Cancer 2004;45[suppl. 2]:S29-37). tween benign and nonbenign lesions, and In 2003, Dr. Jacobs, a research and clin- maybe even to have semiquantitative vi- ical consultant in obstetrics and gynecol- sual differentiation that would allow us to ogy at the university, and Dr. Stefan Paep- make some instant conclusions about the ke began investigating the scientific and lesion. This could really improve the di- clinical potential of autofluorescence duc- agnostic value of the procedure and might toscopy for use in small-lumen endoscopy. even allow earlier therapeutic interven- The prototype chosen for study uses a tion,” said Dr. Jacobs. “We might also be 300-W xenon lamp that emits white light; able to develop this into an early screen- a foot switch adds a blue filter to change ing procedure for [high-risk] patients.” it to a fluorescent excitation light. Under Dr. Jacobs hopes to publish a larger case this spectrum, healthy tissue shines bright- series that will include more data on col- ly, reflecting 100% of the light, while dys- or gradations, and compare the autofluo- plastic tissue reflects a reduced amount, or rescent imaging to standard imaging tech- even none, and fades into blackness. How- niques. ever, this picture isn’t optimal for diag- The most immediate application of aut- nostic evaluation, Dr. Jacobs said in an in- ofluorescent ductal imaging would prob- terview. So the investigators inverted the ably be surgical, he said. “If we could take picture so that healthy areas diminish and a biopsy under autofluorescent visualiza- suspicious areas are highlighted, then over- tion, we might be able to use the color as laid it with an image from the red-violet a guide to getting clear margins. This spectrum to improve detection of poten- might cut down on the number of R1 re- tial lesions. In this final image, suspicious sections, and also reduce the need for con- areas and potential intraductal lesions ap- secutive operations to ensure clear tumor pear blue-violet. margins.” The journal Clinical Breast Cancer has In fact, Dr. Jacobs said, autofluorescent accepted Dr. Jacobs’ technical feasibility diagnostic ductoscopy would combine study for publication. In the paper, he de- very well with interventional ductoscopy. scribes five patients who were examined The color gradations would guide the sur- intraoperatively with this technique. All geon to the suspicious area, which could had either histologically confirmed ductal be treated endoscopically. carcinoma in situ or papilloma that had Neither investigator claims a financial been discovered with other imaging meth- interest in either the procedure or the ods or fine-needle biopsies. unit. ■.
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