乳管镜直视下病灶活检在伴乳头溢液乳管疾病诊断中的应用

目的 研究乳管镜直视下乳管内病灶活检的可行性和意义.方法 2006年5月至2007年4月,共51例有乳管内病灶的患者在复旦大学肿瘤医院接受了53次乳管镜直视下乳管内病灶活检术和随后的开放手术.结果 活检发现29例管内乳头状瘤、15例导管上皮增生、2例上皮重度不典型增生和2例恶性肿瘤.另有5例活检失败.开放手术后病理为12例单发管内乳头状瘤、12例多发性管内乳头状瘤、25例乳腺上皮增生、3例导管内癌、1例浸润性导管癌.结论 乳管镜直视下乳管内病灶活检不仅是微创、安全、方便可行、成功率高的诊断方法,还可部分替代现有开放手术.活检如发现上皮不典型增生或恶性肿瘤,则需进一步手术.

Fiberoptic ductoscopy-guided intraductal biopsy for the diagnosis of intraductal lesions concomitant with pathologic nipple discharge

Objective To investigate the clinical significance of fiberoptic ductoscopy-guided intraductal biopsy in diagnosing nipple discharge.Methods From May 2006 to April 2007,screening fiberoptic ductoscopy was performed for intraductal papillary lesions in 53 ducts among 51 patients.Fiberoptic ductoscopy-guided intraductal biopsy was carried out followed by open microdochectomy. Results Except for a failure in 5 ducts,biopsy found papilloma in 29 cases,ductal hyperplasia in 15 cases,severe ductal hyperplasia in 2 and carcinoma in 2.Microdochectomy revealed 43 benign diseases (12 solitary intraductal papillomas,12 multiple intraductal papillomas,and 25 ductal hyperplasia)and 4 malignancies (3 ductal carcinoma in situ,1 invasive ductal carcinoma).Surgeries performed for the 5 ducts failing a biopsy attempt revealed papilloma in one and adenosis in 4.Compared with conventional microdochectomy,fiberoptic ductoscopy-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma(40.7% vs. 92.6%,P＜0.05).It might also underestimate multiple intraductal papilloma and breast cancer. Conclusion Fiberoptic ductoscopy-guided intraductal biopsy is microinvasive,safe,convenient with a high success rate,and could be as a routine procedure after intraductal lesion found by screening fiberoptic ductoscopy.