伴乳头溢液乳腺癌的乳腺导管造影表现与病理对照研究

目的:分析伴有乳头溢液乳腺癌的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法:临床表现有乳头溢液并经手术、病理证实的乳腺癌23例,回顾性分析其乳腺导管造影的影像表现,并与手术病理结果进行对比分析。结果:23例中原位癌8例,浸润性导管癌10例(包括单纯癌6例、乳头状癌4例),导管癌早期浸润3例,乳头状瘤病恶变2例。病理上诊断早期癌13例(56.5%),其中8例临床未触及乳腺肿块。乳腺导管造影主要表现:导管内充盈缺损并伴有不同程度的导管扩张12例;乳腺肿瘤侵蚀导管形成潭湖征5例;溢液导管受乳腺肿块推挤,导管变形3例;导管持续显影、管壁不规则伴广泛微钙化灶1例。本组中乳腺导管造影诊断乳腺癌的符合率为82.6%。结论:乳腺导管造影对伴有乳头溢液乳腺癌的检出是一项安全、有效的检查方法,能准确观察到肿块与溢液导管的位置关系、溢液导管受侵蚀程度,而且还能检测出临床触诊阴性的早期乳腺癌。     

伴有乳头溢液乳腺癌与导管内乳头状瘤的乳腺导管造影诊断

目的：总结分析伴有乳头溢液乳腺癌以及导管内乳头状瘤的乳腺导管造影X线表现,评价两者的诊断与鉴别诊断价值。方法：回顾性分析经手术和病理证实的23例乳腺癌和36例乳腺导管内乳头状瘤患者的乳腺导管造影检查影像资料。结果：乳腺癌导管造影主要表现为分支导管内不规则的充盈缺损伴导管壁破坏、导管阻塞中断、“潭湖征”等较为典型的征象;导管内乳头状瘤的导管造影主要表现为大导管内光整的充盈缺损,导管壁多无破坏,并伴有导管扩张以及导管扭曲。乳腺瘤与乳头状瘤在充盈缺损、导管壁破坏、导管完全中断、导管扩张以及“潭湖征”等x线征象上差异有统计学意义（P〈0．05）。乳腺导管造影诊断伴有乳头溢液乳腺癌和乳头状瘤的符合率分别为78．3％和80．1％。结论：不规则的充盈缺损伴导管壁破坏、导管阻塞中断、“潭湖征”等征象及发生部位上乳腺癌和乳腺导管内乳头状瘤两者各有特点,是诊断和鉴别诊断的重点。     

乳腺导管造影术在乳腺导管疾病中的应用

目的探讨乳腺导管造影在乳腺导管疾病诊断中的应用。方法回顾分析了56例乳腺导管造影疾病的造影检查资料,病例均经临床检查、钼靶摄片、乳导管造影检查及病理证实。结果肿瘤性病变25例,占44.64%,包括导管内乳头状瘤12例,导管内乳头状癌4例,浸润性导管癌9例;其中导管内乳头状瘤最为多见。非肿瘤性病变31例,占55.36%,其中单纯导管扩张症11例,导管扩张伴慢性乳腺炎18例,单纯导管炎症2例;其中以导管扩张伴慢性乳腺炎最为多见。结论乳腺导管造影术对乳腺导管系统疾病的诊断与鉴别诊断以及导管内乳头状癌的早期诊断具有重要的价值。     

溢液性乳腺癌的乳腺导管造影表现及病理基础

目的:分析溢液性乳腺癌的乳腺导管造影表现及其病理基础,为临床提供可靠的诊断依据,以提高早期乳腺癌的诊治水平。方法:临床表现为乳头溢液并经手术、病理证实的乳腺癌患者26例,回顾性观察其乳腺导管造影表现,并与病理结果对比分析。结果:26例中,导管原位癌8例;浸润性导管癌5例;导管原位癌伴早期浸润7例;复合型癌3例,其中导管原位癌合并浸润性小叶癌2例,浸润性导管癌合并浸润性小叶癌1例;导管内乳头状瘤病癌变3例,其中乳腺X线平片未发现异常5例,毛刺或分叶状肿块2例,肿块伴钙化9例,多形性钙化灶10例。乳腺导管造影主要表现:导管内充盈缺损伴有不同程度导管扩张;导管管壁浸润破坏对比剂渗漏,形成"潭湖征";导管管壁不规则,呈"虫蚀样"改变或"断续征"。本组乳腺导管造影诊断乳腺癌的符合率为88.4%。结论:乳腺导管造影是溢液性乳腺癌诊断的安全而有效的检查方法,具有很高的定性、定位诊断价值,尤其对临床触诊阴性的早期乳腺癌能作出较准确的诊断,提高了早期乳腺癌的检出率。     

乳腺导管造影在乳头溢液病因诊断中的价值

目的　探讨乳腺导管造影在乳头溢液病因诊断中的价值。方法　回顾性分析 40例乳头溢液乳腺导管造影X线表现 ,并经临床治疗或手术病理证实。结果　正常导管 7例 ,单纯导管扩张 17例 ,导管扩张伴炎症 4例 ,导管扩张伴增生 2例 ,导管内乳头状瘤 8例 ,乳腺导管癌 1例 ,乳腺脓肿 1例。结论　乳腺导管造影术对乳头溢液为主要症状的病因具有较高的诊断价值 ,为临床提供准确的诊断和治疗依据     

乳腺单发乳头状瘤钼靶X线诊断（附42例报告）

目的：提高对乳腺单发乳头状瘤放射学诊断水平。材料与方法：作者回顾分析了４２例经病理证实的乳腺导管内单发乳头状瘤临床表现，钼靶平片及造影片表现。结果：３７例（８８％）有乳头分泌物。９５％（３５／３７）发生于中央大导管。２４％（１０／４２）平片有异常改变。造影表现：５４％（２０／３７）表现导管内充盈缺损，４１％（１５／３７）表现导管完全阻塞，４３％（１６／３７）有导管轻度扩张。结论：乳头溢液为导管内乳     

Conventional galactography and MR contrast galactography for diagnosing nipple discharge: preliminary results

OBJECTIVE: We wanted to compare the clinical usefulness of conventional galactography and MR contrast galactography for diagnosing patients with nipple discharge. MATERIALS AND METHODS: Both conventional galactography and MR contrast galactography were performed prospectively in 16 patients. Gadopentate dimeglumine (0.1 ml) was mixed with non-ionic contrast medium (0.9 ml) to obtain a resultant volume of 1 ml and this was used for both examinations. Following conventional galactography, MR contrast galactography was performed after direct injection of contrast media into the duct. RESULTS: Conventional galactography and MR contrast galactography were concordant in 13 (81%) of 16 patients; the results were normal in five, ductal dilatation was noted in four and intraductal filling defects were noted in four. The remaining three (19%) patients demonstrated discordant findings on the two examinations. While conventional galactography revealed filling defects, the MR contrast galactography results were normal in two patients. The third patient had kinks-stricture on conventional galactography and MR contrast galactography showed ductal dilatation. This suggested there were false positive results for the three patients' conventional galactography, and all the three patients with discordant results underwent surgery and the histopathologic evaluation showed fibrocystic changes. CONCLUSION: MR contrast galactography may be used as an alternative imaging modality for making the diagnosis of pathologic nipple discharge. However, statistically supported studies with large pools of subjects for comparing the galactography and MR contrast galactography results are needed to confirm our findings.     

乳腺导管造影结合乳管内视镜对乳头溢液的诊断价值(附100例分析)

目的通过乳腺导管造影和乳管内视镜检查,进一步提高乳腺导管系统疾病的诊断正确率。方法回顾性分析100例乳腺导管系统疾病患者的乳腺导管造影与内视镜检资料。结果肿瘤样疾病占14%,包括导管内乳头状瘤、乳头状瘤病和导管内癌,以导管内乳头状瘤及乳头状瘤病多见,占12%。非肿瘤性疾病占71%,包括导管扩张症、导管扩张并慢性炎症、浆细胞性乳腺炎、乳腺囊肿、乳腺小叶增生、乳腺囊性增生,以导管扩张症多见,占42%。结论乳腺导管造影与乳管内视镜对导管系统疾病的诊断很有价值。     

乳腺导管造影在溢液乳腺疾病诊断中的应用价值(附70例报告)

目的探讨乳腺导管造影在溢液乳腺疾病诊断中的应用价值。方法回顾性分析70例经手术及病理确诊的乳头溢液乳腺病的X线特点,结合临床及病理特征进行鉴别诊断。结果导管内乳头状瘤45例,导管癌5例,导管扩张症17例,导管增生伴炎症3例。结论乳腺导管造影在导管肿瘤良恶性的鉴别及导管炎性疾病的诊断中有极高的应用价值,可为临床提供准确的诊断和治疗依据。     

Role of breast Magnetic Resonance Imaging (MRI) in patients with unilateral nipple discharge: preliminary study

PURPOSE: This study was performed to assess the role of magnetic resonance imaging (MRI) in patients with unilateral nipple discharge. MATERIALS AND METHODS: Forty-four patients with bloody or serosanguineous nipple discharge and negative mammographic findings (35/44 cases) underwent MRI for evaluation of breast ducts. Ultrasonography, negative in 18 patients, identified 26 cases of ductal ectasia (12 simple, nine with solid intraductal echoes and wall thickening, five with inhomogeneous parenchyma). Galactography was negative in three patients and positive in nine. Nineteen patients were followed up by clinical examination, ultrasonography, and cytological evaluation of nipple discharge (6-12 months); three patients underwent excisional biopsy, ten core biopsy and 12 cytological biopsy (followed by excisional biopsy). RESULTS: MRI identified 25 enhancing lesions Breast Imaging Reporting and Data Systems (BI-RADS) 3 or 4) and confirmed the galactographic findings (ductal ectasia, intraluminal filling defects). Five papillomatoses appeared as patchy, homogeneous enhancing areas, 15 intraductal papillomas as areas with well-defined margins and type II time-intensity curves, and two atypical ductal hyperplasias as diffuse nodular enhancement. One micropapillary ductal carcinoma in situ (DCIS), one papillary carcinoma and one infiltrating ductal carcinoma (IDC) were visualised as two segmental areas of enhancement and one mass-like enhancement with poorly defined margins (BI-RADS 4). The follow-up was negative, showing no pathological enhancement (BI-RADS 1) in 12 patients and benign enhancement (BI-RADS 2) in seven. CONCLUSIONS: Breast MRI can be considered a valuable examination in the diagnosis of suspected ductal disease and an alternative to galactography when the latter cannot be used.     

乳腺增生症的影像学诊断

目的:评价影像检查对乳腺增生症诊断与鉴别诊断中的作用。材料和方法:回顾性分析74例乳腺增生症的临床和影像学表现。74例均做了钼靶X线摄影检查,其中19例做了选择性乳腺导管造影、10例超声检查和3例核磁共振检查。结果:74例钼靶X线平片检查表现为片状高密度影44例(59.5%),结节影18例(24.3%),无异常发现者12例(16.2%)。19例乳头溢液患者的选择性乳腺导管造影表现为囊肿型8例,囊肿伴导管硬化型6例,导管增生硬化型3例,终末导管囊性扩张型2例。10例肿块性患者的超声表现:实性病变8例,呈低回声;囊性病变2例,呈无回声液性暗区,伴有明显的后回声增强效应。3例乳腺囊肿,T1WI呈均匀低信号,T2WI呈均匀的高信号。结论:乳腺增生症的多种影像学表现反映其复杂多样的病理特点,钼靶X线摄影联合超声、MRI检查对肿块性病变的诊断与鉴别诊断有很重要的意义;选择性乳腺导管造影对乳头溢液患者的诊断帮助很大。     

Predictive value of galactographic patterns for benign and malignant neoplasms of the breast in patients with nipple discharge

The purpose was to identify features of malignant and non-malignant neoplastic breast disease on galactography and to estimate their predictive value. This is the largest reported study correlating galactographic morphological patterns with histopathology and the only blinded study. The study included 351 consecutive galactograms and 161 breast biopsies performed in patients with nipple discharge over a 10-year period. Three radiologists, blinded to clinical data and histological results, re-evaluated 158 previously performed galactograms of patients who had undergone excision biopsy. Extravasation or incomplete filling precluded reading in 9.5% of examinations. Among the remaining 143 examinations there were 11 cancers (7.7%), 56 papillomas (39.2%), 19 cases of intraductal papillomatous proliferation (13.3%), 55 cases of fibrocystic or secretory disease (38.5%) and two normals. A "filling defect/cut-off" pattern (n = 90) was found in 6 cancers (6.7%) and 58 cases of papilloma or papillomatous proliferation (64.4%). A "leafless tree" pattern was found only in benign cases (n = 12; 8.4%). In 32 of 143 cases (22.4%) a "ductal ectasia" pattern was present, in one case of which (3.1%) cancer was found. Cancer was identified in two of four cases with an "architectural distortion" pattern. Cancer is rare in patients with nipple discharge. A tendency towards a lower incidence of cancer associated with the "ductal ectasia" and "leafless tree" patterns was found. No statistical evidence was found to indicate that galactography provides an effective prospective diagnosis of malignancy. However, an abnormal galactogram strongly correlated (p < 0.001) with the presence of a breast neoplasm when both benign and malignant tumours were considered. The most important role played by galactography is in the localization of breast neoplasms and in the choice of appropriate surgical therapy.     

溢液性乳腺病166例X线诊断

目的进一步提高溢液性乳腺病的X线诊断水平。方法回顾性分析经手术、病理证实,资料完整的166例溢液性乳腺病的乳腺导管造影表现。结果乳腺导管扩张症78例:导管扩张增粗、管壁光滑;导管扩张伴炎症2例:导管扩张、管壁毛糙,造影剂渗入间质;乳腺囊性小叶增生11例:末梢导管扩张呈囊状、管径粗细不均;导管内乳头状瘤49例:圆形、类圆形充盈缺损,导管呈“杯口状”中断,边缘光整;导管内乳头状癌、导管内癌26例:导管扩张后狭窄,导管中断呈“刀切样”平直,管腔僵硬,充盈缺损呈圆形菜花状或不规则状。肿瘤性病变75/166例,占45.1%;其中恶性病变26/75例,占15.7%。结论乳腺导管造影对溢液性乳腺病的诊断与鉴别诊断有重要价值。     

溢液性乳腺病导管造影50例分析

本文报告210例乳腺导管造影的经验,重点分析50例经病理证实的溢液性乳腺疾病的造影所见。结果表明,乳腺导管造影对各种溢液性乳腺疾病的诊断正确率达96％,并对良、恶性病变引起乳腺导管不同X线表现进行了讨论。     

溢液性乳腺疾病导管造影X线征象与病理结果分析

目的:分析溢液性乳腺疾病的乳腺导管造影表现及病理基础,以提高其X线诊断水平。方法:回顾性分析216例溢液性乳腺疾病患者的导管造影及病理资料。结果:共有226支导管造影成功。无明显异常呈阴性表现者占7.5%(17/226);肿瘤性疾病占26.5%(60/226),包括导管内乳头状瘤、导管癌,其中以导管内乳头状瘤多见(22.0%);非肿瘤性疾病占59.7%(135/226),包括导管扩张、炎症及乳腺囊性增生,其中以炎症最多见(39.4%,89/226)。结论:乳腺导管造影对溢液性乳腺疾病的诊断与鉴别诊断有重要价值。     

乳腺导管造影技术在非哺乳期乳头溢液中的应用

目的：探讨乳腺导管造影技术在非哺乳性溢液中的质量控制。方法：对106例非哺乳性溢液的女性患者行乳腺导管造影。并对多乳眼溢液行多次乳腺导管造影检查。结果：106例中93例造影成功，成功率为87．7％。42例为导管占位性病变，阳性率45．2％。结论：乳腺导管造影在非哺乳性溢液患者的检查中是一种简单安全的技术，在乳腺导管系统疾病的诊断和鉴别诊断中起到了重要作用。     

Breast disease in the male: galactographic evaluation

Seven men with unilateral nipple discharge underwent galactography. In two patients the diagnosis was carcinoma, two were benign papillomas, one was a breast abscess, and two were ductal ectasia. Galactography is useful in men and women with nipple discharge, especially when the discharge is bloody and there is no palpable tumor. The precise location of an intraductal lesion through the use of galactography guides the biopsy and makes conservative surgery easier.     

Correlation of ultrasound and galactography in the diagnosis of nipple discharge. Preliminary results

INTRODUCTION: Several pathologic conditions involving the breast ductal tree can cause bloody or serous nipple discharge. Galactography plays a major clinical role in identifying and localizing intraductal masses, but its sensitivity in detecting cancer is certainly suboptimal. Presently high-frequency ultrasound (US) probes allow detection and guided biopsy of intraductal lesions. We compared the specific information provided by US and galactography in the discharging breast. MATERIAL AND METHODS: Thirty-three patients with discharging breast were submitted to both diagnostic examinations. US was performed with 13 MHz scanheads both before and after galactography. Galactography was performed with 30-31 G catheters to cannulate the discharging duct. Nonionic, water-soluble, sterile contrast material was administered. Postgalactography US was performed to investigate if it could yield further information. The final diagnosis was made at histology and 2 years' instrumental follow-up. RESULTS: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were evaluated for both techniques. We considered a positive finding the detection of a lesion in general (be it papilloma, papillomatosis, or cancer), as well as the detection of carcinoma only. Sensitivity was 96% for galactography and 84% for US in the former case, versus 50% and 100%, respectively, in the latter. Postgalactography US added no major information. DISCUSSION AND CONCLUSION: US is more sensitive than galactography in cancer diagnosis and, it permits guided biopsy and preoperative localization of unpalpable ductal lesions. In our limited experience, US can be considered a complementary diagnostic tool to galactography in the discharging breast.     

Case report: galactography-guided wire localization of an intraductal papilloma

Galactography is used to evaluate spontaneous unilateral nipple discharge by catheterization of the duct orifice and instillation of radiopaque contrast material. The most common cause of a bloody discharge is an intraductal papilloma which appears as a smooth lobulated intraluminal filling defect or a solitary obstructed duct on galactography. Carcinomas may be the cause of up to 13% [1] of abnormal nipple discharge and cannot be reliably distinguished from papillomas at galactography. Thus any intraductal filling defect or irregularity in symptomatic patients should be surgically evaluated to obtain a tissue diagnosis. Unfortunately, the histologic examination of the biopsy specimen does not always identify the lesion seen at galactography [2]. A potentially more reliable method of locating lesions identified on galactography is described. Chow, J. S. (2001). Clinical Radiology56, 72-73.     

Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy?

The purpose of this study was to determine the value of galactography-guided, stereotactic, vacuum-assisted breast biopsy (VABB) for the assessment of intraductal breast lesions and its potential as a therapeutic tool that could eliminate the need for surgical excision. Eighteen patients (median age 64 years, range 37–80) with nipple discharge and galactography-verified intraductal lesions underwent galactography-guided, stereotactic, 11-gauge VABB followed by surgery. Histopathology findings from VABB and subsequent surgery were compared. Underestimation and false-negative rates were assessed. After VABB, histopathology revealed invasive ductal carcinoma (IDC) in three (17%), ductal carcinoma in situ (DCIS) in six (33%), high-risk lesions in six (33%) and benign lesions in three (17%) cases. After surgical biopsy, histopathology confirmed the previously established diagnosis in 11 lesions (61%). The underestimation rate for high-risk lesions and DCIS was 50% (6/12). The false-negative rate was 7% (1/14). Histopathology examination after surgery showed that not a single lesion had been completely removed at VABB. Galactography-guided VABB is a feasible diagnostic tool. However, its value as a therapeutic procedure is limited because of the high number of underestimated and missed lesions and because of the histopathological detection of lesions’ remnants in every case. Surgical excision should be the therapeutic gold standard in cases of pathological nipple discharge and galactography abnormalities.