The majority of benign and malignant breast diseases originate in the ductal system. Breast ductoscopy (BD) allows direct access to this ductal system and thus holds great promise in the diagnosis and surgical management of a number of breast diseases. BD was first developed over 20 years ago to investigate nipple discharge. Indeed, till now, this remains the most common indication. However, BD technology has been further developed for a variety of new clinical applications. For example, BD-guided ductal ravage combined with molecular and genetic analysis can be a powerful screening tool for women at high-risk of breast cancer. BD can also be used during lumpectomy to identify additional radiographically occult disease. This refined intraoperative margin assessment can help surgeons to achieve clear margins at the first excision while optimizing the extent of resection. In the future, this same precise intraoperative margin assessment may facilitate a variety of local ablative techniques including laser Over time, BD is likely to evolve beyond its current technological limitations to realize its full diagnostic and therapeutic potential. The article describes the technique of BD, reviews its evolution and discusses current and future applications.