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Purpose: Bloody nipple discharge is the only clue in the detection of intraductal carcinoma of the breast that does not display a mass and calcifications.Since sensitivity of discharge cytology is not sufficiently high and mammary ductendoscopy (MS) contributes the diagnosis of intraductal lesions.We set out to determine whether the intraductal approach iseffective for detection and diagnosis of ductal carcinoma.Materials and Methods: We performed 462MS procedure in 343 patients who had nipple discharge but no overt mass between October 1993 and May2009 at Tokyo Metropolitan Cancer Detection Center (October 1993 to December 2002), Minamiaoyama Breastopia Clinic (April 2003 to June 2006), and Tokyo Medical University Hachioji Medical Center (November 2006 to September 2009).The diagnostic accuracy rates of discharge cytology and intraductal breast biopsy (IDBB) were studied in detecting malignancy.The therapeutic value of IDBB for intraductal papillomas was studied in 73 patients.Results:Of 343 patients, 81 had breast cancer and 163 had intraductal papillomas.MS detected intraductal tumors in 47 of 81 intraductal cancer cases (58.0%).IDBB was performed in 35 of these 47 cancer eases.The sensitivity was 34.6%by touch cytology, 68.6% by IDBB, and 86.8% by directed ductal lavage cytology.Of the 73 intraductal papilloma patients who were followed for more than 3 years, the therapeutic effectiveness of IDBB was recognized in 57 (78.1%).Conclusions: Directed duetal lavage cytology was the most sensitive method in detecting malignancy.MS and IDBB were benefit in the treatment of intraductal papilloma.