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Review
. 2021 Apr;186(2):285-293.
doi: 10.1007/s10549-021-06094-x. Epub 2021 Jan 21.

Meta-analysis and cost-effectiveness of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge

M D Filipe  1 , S I S Patuleia  2 , M R Vriens  3 , P J van Diest  2 , A J Witkamp  3
Affiliations
Review

Meta-analysis and cost-effectiveness of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge

M D Filipe et al. Breast Cancer Res Treat. 2021 Apr.

Abstract

Introduction: Pathological nipple discharge (PND) is a common breast-related complaint for referral to a surgical breast clinic because of its association with breast cancer. The aim of this meta-analysis was to compare the diagnostic efficacy of magnetic resonance imaging (MRI) and ductoscopy in patients with PND. Additionally, we determined the most cost-efficient strategy for the treatment of PND and the detection of breast cancer in PND patient without radiological suspicion for malignancy.

Materials and methods: PubMed and EMBASE were searched to collect the relevant literature from the inception of both diagnostic methods until January 27th 2020. The search yielded 815 original citations, of which 10 studies with 894 patients were finally included for analysis. Costs of ductoscopy, MRI and duct excision surgery were obtained from the UMC Utrecht as established in the year 2019. These costs included: medical personnel, overhead costs, material costs and sterilisation costs.

Results: The meta-analysis showed no significant difference in sensitivity between ductoscopy (44%) and MRI (76%) for the detection of malignancy in patients with PND. However, ductoscopy (98%) had a statistically significantly higher specificity than MRI (84%). Individual costs were €1401.33, €822.13 and €6494.27 for ductoscopy, MRI and duct excision surgery, respectively. Full diagnostic strategy involving ductoscopy was on average €1670.97, while with MRI it was €2070.27.

Conclusion: Patients undergoing MRI are more often (false) positive which more often leads to duct excision surgery referrals compared to ductoscopy. This makes ductoscopy significantly more cost-effective compared MRI in patients with PND without radiological suspicion for malignancy.

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Figures

Fig. 1
Fig. 1
Flow chart showing literature search and study selection with 10 relevant studies ultimately enrolled in the meta-analysis. N number, TP true positive, TN true negative, FN false negative, FP false positive
Fig. 2
Fig. 2
Meta-analysis of sensitivity and specificity of ductoscopy and MRI for detection of breast cancer in patients with pathologic nipple discharge. MRI magnetic resonance imaging, CI confidence interval
See this image and copyright information in PMC

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