Lessons learned from 416 cases of nipple discharge of the breast

Background

For patients with nipple discharge (ND), surgical duct excision is often required to exclude underlying malignancy. Our objective was to define clinical predictors of malignancy and examine the utility of common preoperative studies.

Study design

We retrospectively identified 475 patients presenting with a chief complaint of ND from 1995 to 2005; 416 (88%) were eligible for review.

Results

Following standard evaluation (clinical breast examiation/mammogram/ultrasound), 129 of 416 (31%) were considered to have physiological ND and were managed expectantly, whereas 287 of 416 (69%) underwent further evaluation (cytology/ductography/magnetic resonance imaging) followed by biopsy ± surgery. Clinical features associated with pathological ND included bloody ND (adjusted odds ratio 3.7) and spontaneous ND (adjusted OR 3.2). Biopsy/surgery identified a causative lesion in 259 of 287 (90%), of which 37% were either malignant (n = 65) or high-risk (n = 30) lesions. The sole clinical predictor of malignant/high-risk lesion was a palpable mass (adjusted odds ratio 4.3). Preoperative evaluation identified 76 of 95 (80%) malignant/high-risk lesions, whereas 19 of 95 (20%) were identified by duct excision alone.

Conclusions

Although clinical stratification alone reliably identified patients with pathological ND, neither the clinical characteristics nor preoperative studies can reliably distinguish between benign and malignant pathology. Surgical duct excision remains the gold standard to exclude underlying malignancy.     

89例乳头溢液的外科治疗

目的探讨89例乳头溢液患者的外科治疗效果。方法对我院于2004年1月至2009年9月收治89例乳头溢液患者,分别采用乳腺区段切除,单纯乳房切除或者改良根治术进行回顾性分析。结果术后病理类型：乳腺导管内乳头状瘤57例,乳腺增生21例,导管扩张5例．导管癌4例,浸润性导管癌2例。结论乳头溢液最常见的原因是乳管内乳头状瘤,其次是乳腺增生。乳腺导管扩张及导管癌。乳头溢液以手术治疗为主,术式应根据病理决定。行术中冰冻切片病理活检可以确定病理类型。     

乳腺导管内视镜检查对乳头溢液的诊断价值

目的 探讨乳管内视镜对乳头溢液的诊断价值.方法 应用FV-2000E日本超细光导纤维乳管内视镜系统对3267例乳头溢液患者进行乳管内视镜检查,并将检查结果进行病理学分析.结果 本组3267例患者,正常管腔499例(15.27%);导管扩张伴慢性炎症1750例(53.57%);发现乳管内占位病变1018例(31.16%)(溢液性质血性813例,浆液性165例,水样40例),在813例血性溢液中发现浸润性导管癌42例,导管内癌8例.结论 乳管内视镜检查对乳头溢液患者是一种安全有效的检查方法,应作为病因诊断的首选方法.     

经奶嘴甜味剂喂服对新生儿静脉穿刺疼痛的影响

目的：了解经奶嘴甜味剂喂服对新生儿静脉穿刺疼痛的影响,为新生儿疼痛管理提供新的思路和方法。方法：选取180例新生儿作为研究对象,其中89例早产儿、91例足月儿,将患儿随机分为对照组和干预组,干预组穿刺前给予经奶嘴甜味剂喂服,对照组无干预,两组患儿穿刺时利用新生儿疼痛评分法对疼痛进行评估。结果：足月儿和早产儿中干预组疼痛评分明显低于对照组（P〈O．01）。结论：经奶嘴甜味剂喂服能有效减轻新生儿静脉穿刺时的疼痛反应。     

乳腺导管内乳头状病变糖类抗原153、癌胚抗原及糖类抗原125联合检测的临床价值

目的 探讨乳头溢液糖类抗原153（CA153）、癌胚抗原（CEA）及糖类抗原125（CA125）联合检测在乳腺导管内乳头状病变诊断中的价值.方法 检测154例乳腺导管内乳头状病变患者（恶性组58例,良性组96例）乳头溢液中CA153、CEA及CA125的水平,分析其诊断价值及其与临床病理因素的关系,另选30例妊娠健康妇女乳头溢液作对照.结果 恶性组乳头溢液中CA153、CEA及CA125水平[（130.11±29.62）U/ml、（89.23±28.94） ng/ml、（41.29±16,61）U/ml]显著高于良性组和健康组（P＜0.01）;与良性组和健康组比较,恶性组溢液中CA153、CEA、CA125单项检测阳性率（62.07％、46.55％、55.17％）及联合检测阳性率（82.76％）均明显增高（P＜0.05）;恶性组乳头溢液联合检测阳性率显著高于单项检查（P＜0.01）.乳头溢液及血清三项联合检测可提高敏感性（96.55％）和阴性预测值（97.30％）.溢液CA153、CEA、CA125水平在患者年龄、部位、肿瘤大小、溢液性状不同组间差异无统计学意义（P＞0.05）;溢液CA153、CEA水平在雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体-2（Her-2）、缺氧诱导因子-1α（HIF-1 α）及淋巴结转移不同组差异有统计学意义（P＜0.05）;CA125在HIF-1 α、Ki-67不同组间差异有统计学意义（P＜ 0.05）;CA125在ER＆ PR、Her-2不同组间,CA153水平在Ki-67不同组间差异无统计学意义（P＞0.05）.结论 乳头溢液及血清CA153、CEA及CA125联合检测有互补性,能弥补单项检测临床应用的不足,对提高乳腺导管内乳头状癌诊断的敏感性和阴性预测值有一定意义.     

乳头溢液性疾病的超声征象与乳管内窥镜检查结果的对比分析

目的 评价超声对乳头溢液性疾病的临床诊断价值.方法 对57例乳头溢液性疾病患者分别行超声和乳管内窥镜检查,将超声征象与乳管镜结果进行对比分析.结果 超声对乳头溢液性疾病阳性征象诊断率为96.49%:导管扩张27例(47.36%),实性肿物伴导管扩张或囊肿19例(33.33%),囊性回声6例(10.52%),实性回声3例(5.26%),超声无异常征象2例(3.51%).乳管镜诊断:乳腺导管炎26例(45.61%),导管扩张症12例(21.05%),导管内乳头状瘤或乳头状瘤病17例(29.82%),乳腺癌2例(3.50%).超声对实性病变的诊断敏感性为52.63%,特异性为89.47%,误诊率为10.50%,漏诊率为47.36%.结论 超声对乳头溢液性疾病有较高的敏感性,但对此类疾病中实性病变的漏误诊率较高.     

剖宫产术后乳头刺激与婴儿吸吮对子宫收缩及阴道出血量的影响

目的观察剖宫产术后24小时内乳头刺激与婴儿吸吮对子宫收缩及阴道出血量的影响,探讨减少产后出血的护理方法。方法选择162例剖宫产术后,无内外科合并症,无严重妊娠合并症,新生儿体重2500～3500g,妊娠次数3次以内的初产妇,分为甲乙两组,甲组85例指导和协助其在术后24小时内给予频繁吸吮和乳头刺激各8次,乙组77例指导和协助其在术后24小时内给予吸吮8次。结果 24小时阴道出血量甲组(68.31±32.65)ml,乙组(91.19±42.62)ml,差异有统计学意义(t=-3.808,P0.0001)。甲组中58例子宫收缩好,阴道出血量60ml;24例子宫收缩好,阴道出血量80ml,3例阴道出血量80ml;乙组8例子宫收缩好,阴道出血量60ml,24例子宫收缩好阴道出血量80ml,45例阴道出血量80ml。结论剖宫产后24小时内婴儿吸吮并进行乳头刺激,可作为减少产后出血的护理方法之一。     

楔形真皮乳腺瓣法矫正重度乳头内陷

目的探讨矫正女性重度乳头内陷的手术治疗新方法。方法设计乳晕去表皮楔形真皮乳腺瓣,双侧楔形瓣翻转180°交叉重叠置于乳头基部,以支撑乳头和缩小乳头颈部直径。应用不可吸收的缝线分层严密缝合创口,消除乳头可能回缩的空间,缩窄乳头颈部皮肤。结果2002年7月至2008年12月,采用该方法共治疗35例先天性或复发性重度乳头内陷患者,全部病例术后伤口均愈合良好,无血肿、感染等并发症。术后随访3个月至2年,切口瘢痕不明显,乳头高度及外形满意,无复发。结论楔形真皮乳腺瓣法是矫正重度乳头内陷和术后复发的一种较好的手术治疗方法,尤其对防止乳头内陷的术后复发具有良好效果。     

Mammary ductoscopy: current issues and perspectives

Until recently, the mammary duct had not been directly observed in vivo. Starting with the success of Teboul et al., studies of mammary ductoscopy (MD) for nipple discharge have been performed in Japan and other East Asian countries. Ductal lavage screening trials for breast cancer started in the 2000s. Concurrently, the number of English-language articles about MD increased. Sixty-nine English-language and 74 Japanese-language papers published in the last 19 years were reviewed. Important reports and studies were analyzed. MD has undergone significant technological development, and studies of MD have taken place in many countries. As a result, endoscopic images of the mammary duct have developed, and the endoscopic diagnosis for nipple discharge has become possible. MD-guided biopsy and surgery have been studied. Findings of MD are useful for diagnosing intraductal lesions with nipple discharge. As a result, MD has reduced the number and extent of microdochectomies. MD is also helpful in guiding breast-conserving surgery. Many pioneers have tried direct biopsy or interventions under MD, but further developments are necessary for its practical use.