乳头溢液导管造影技术的临床应用

乳腺导管造影技术是早期诊断乳腺导管疾病的重要手段。但只有造影成功,才能为诊断医生提供有价值的高质量乳腺导管影像照片,因此应掌握和控制乳腺导管造影技术要点,确保造影成功,从而提高乳腺导管内疾病的检出率。笔者对本院近年来82例乳腺单孔溢液患者进行乳腺导管造影检查的技术要点总结如下。     

乳腺导管造影在溢液性乳腺癌诊断中的应用

目的：探讨不同病理类型的溢液性乳腺癌在乳腺导管造影中的X线征象,提高对本病的诊断水平。方法：搜集经手术病理证实并行乳腺X线片及腺导管造影检查的乳腺癌108例,溢液性质为血性62例,浆液46例,临床因溢液而疑及乳腺癌。分析不同病理类型乳腺癌（浸润性导管癌64例,浸润性小叶癌23例,其他21例包括髓样癌7例,化生性癌1例,富于脂质癌2例,导管原位癌7例,粘液癌1例,浸润性乳头状癌3例）在乳腺导管造影中的X线征象。结果：乳腺癌导管造影主要征象：鼠尾征13例,导管走行僵直16例,充盈缺损（杯口征）7例,导管扩张99例,截断征（刀切征）24例,导管结构紊乱60例,断续征37例,虫蚀样改变30例,潭湖征32例。108例乳腺癌中有106例合并两种以上征象。浸润性导管癌最多见,64例,占50%;其次为浸润性小叶癌,23例,占21.3%。结论：充分认识溢液性乳腺癌的乳腺导管造影征象,对进一步明确乳腺癌的诊断具有重要价值,合并征象越多,对乳腺癌的诊断价值越高。     

乳腺导管造影技术在乳头溢液性疾病检查中的质量控制

乳腺导管造影作为查找溢液病因的首选检查方法,是一种安全、技术比较简单、诊断率高的方法[1].但目前采用的常规乳腺导管造影方法,尚存在操作难度相对大,分支导管显影不足,对比剂易进入腺泡导致诊断困难等问题.笔者针对造影检查中常遇到的几种因素进行分析,探讨如何改进技术以提高造影的成功率和造影质量.     

数字钼靶摄影乳腺导管造影对伴乳头溢液导管癌的诊断

目的 评价数字钼靶摄影选择性乳腺导管造影对伴乳头溢液导管癌的诊断.方法 回顾性分析11例导管癌伴有乳头溢液的乳腺导管造影检查资料,所有病例均常规进行数字钼靶摄影、患侧乳腺导管造影并经手术后病理证实.结果 乳腺钼靶摄影平片阳性7例,乳腺导管造影阳性11例.造影表现为乳腺导管管壁破坏3例,充盈缺损4例,乳腺导管中断11例、僵硬3例、断续征6例,乳腺导管树的"枯树枝"或"残树枝"状改变2例、潭湖征4例,伴有病变近端乳腺导管扩张3例.结论 乳腺导管造影对诊断伴有溢液的导管癌,尤其对导管内癌或癌前期病变具有定位、定性诊断价值,并且对外科医师确定手术切除范围具有指导意义.     

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.     

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。     

乳腺导管造影联合导管内窥镜对溢液性乳腺疾病的诊断价值

目的 :评价乳腺导管造影联合导管内窥镜对溢液性乳腺疾病的诊断价值。方法 :对216例乳头溢液患者同时行乳腺导管造影与导管内窥镜检查,并与病理结果进行对比分析。结果:病理诊断中央性乳头状瘤62例,其中乳腺导管造影正确诊断56例,符合率90.3%,导管内窥镜诊断60例,符合率96.8%;病理诊断外周性乳头状瘤9例,造影诊断7例,符合率77.8%,内窥镜诊断5例,符合率55.6%;病理诊断乳腺癌12例,造影诊断10例,符合率83.3%,内窥镜诊断7例,符合率58.3%。结论:乳腺导管造影联合导管内窥镜可以提高溢液性乳腺疾病的诊断率,减少漏诊率及误诊率。     

乳头溢液性疾病的高频超声与乳腺导管声学造影的对比研究

目的:探讨乳腺导管声学造影对乳头溢液性病变的诊断价值。方法:34例乳头溢液患者术前均行高频超声及声学造影检查,所有检查结果均与手术病理结果比较。结果:乳头溢液疾病高频超声及声学造影检查结果与手术病理结果比较诊断符合率分别为61.7%及79.4%,二者比较差异无统计学意义(P>0.05)。导管内乳头状瘤高频超声与声学造影诊断符合率分别为40%及73.3%,二者比较差异有统计学意义(P<0.05)。结论:乳腺导管声学造影可提高导管内小病变的检出率,显示详细的病变部位及扩张的导管,为手术提供重要的参考依据。尤其是导管内乳头状瘤声学造影检查明显优于高频超声检查。此种检查简单、方便、准确性较高,可作为乳头溢液性疾病的首选检查方法。     

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.     

纤维乳腺导管镜在乳头溢液中的诊断价值

 目的 探讨纤维乳腺导管镜(fiber ductoscopy, FDS)在乳头溢液疾病诊断中的应用价值。方法 选取2016-07至 2018-07乳腺科的250例乳头溢液患者,采用FDS检查,分析其诊断的价值,并分析FDS下特征表像在导管癌和非导管癌差异 ,并进一步分析特征表现区别良恶性疾病能力大小。结果 FDS诊断癌与术后病理报告的符合率为70.0%,诊断导管内乳头状瘤符合率80.0%,诊断导管内乳头状瘤病符合率66.7%,总符合率为77.3%。FDS鉴别诊断乳腺良恶性的灵敏度为73.3%(11/15),特异度为89.0%(73/82)。管壁是否光滑、瘤体是否带蒂、瘤体表面是否有颗粒、瘤体颜色区别、末梢出血量的多少在非导管癌与导管癌中具有明显的差异性,差异有统计学意义(P<0.05)。管壁是否光滑区别导管癌与非导管癌的ROC曲线下面积为0.79,瘤体是否带蒂区别导管癌与非导管癌的曲线下面积0.78 ,瘤体表面是否有颗粒区别导管癌与非导管癌的曲线下面积0.75,瘤体颜色导管癌与非导管癌的曲线下面积为0.67,导管末梢是否大量出血区别导管癌与非导管癌的曲线下面积为0.64。结论 FDS在乳头溢液中具有较好诊断价值,管壁情况、瘤体带蒂、瘤体表面颗粒对区别良恶性乳腺疾病具有重要的价值。     

MR imaging in patients with nipple discharge: initial experience

PURPOSE: To investigate the potential of magnetic resonance (MR) imaging in patients with nipple discharge. MATERIALS AND METHODS: Between February 1992 and December 1998, 23 patients with nipple discharge underwent contrast material-enhanced MR imaging at 1.5 T. Mammographic findings were negative in 22 of 23 patients and revealed asymmetry in one patient. Galactography was attempted in two patients, with negative findings in one patient and no success in the other. Fifteen of 23 patients underwent excisional biopsy-seven of 15 with MR imaging-guided localization, and one of 15 with mammographic localization. Eight of 23 patients were followed up clinically (range, 7-24 months; mean, 20 months). RESULTS: In 11 of the 15 (73%) patients who underwent excisional biopsy, MR imaging findings correlated with histopathologic findings. MR imaging demonstrated four of six benign papillomas and one of two fibroadenomas as circumscribed, enhancing subareolar masses. Findings of one MR imaging examination were negative, and benign tissue was found at excisional biopsy. MR imaging findings were suspicious in six of the seven patients with excisional biopsy findings of malignancy (regional enhancement [n = 2], ductal enhancement [n = 2], peripherally enhancing mass [n = 1], and spiculated mass [n = 1]). In one of the seven patients, a benign-appearing intraductal mass was identified at MR imaging; excisional biopsy revealed a benign papilloma with an adjacent focus of DCIS. CONCLUSION: MR imaging can help identify both benign and malignant causes of nipple discharge. It potentially offers a noninvasive alternative to galactography.     

Galactography: the diagnostic procedure of choice for nipple discharge

Galactography was performed in 204 women with a nipple discharge and the secretion confirmed histopathologically. All 116 intraductal tumors (papilloma, papillomatosis, carcinoma), which were associated with a serous or bloody discharge, were detected preoperatively. A palpable mass had little diagnostic significance, and exfoliative cytology was positive in only 11% (2/18) of the patients with carcinoma. The authors recommend that all patients with a spontaneous bloody or serous discharge from a single lactiferous orifice undergo galactography in addition to physical, cytological, and mammographic examination. Intraductal injection of methylene blue dye will demonstrate the affected duct system to the surgeon and can often make surgery less radical or even unnecessary.     

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.     

高频超声对乳头溢液性病变的诊断价值

目的探讨应用高频超声对乳头溢液性病变的诊断价值。方法对92例乳头溢液患者术前应用高频超声进行乳腺检查，检查结果与手术病理结果相对照。结果92例中最多见的是导管内乳头状瘤(69．57％)，其次为乳腺囊性增生病(26．74％)、乳腺导管扩张症(5．43％)、导管内乳头状癌(3．26％)。高频超声对乳头溢液性病变的诊断准确率、敏感性和特异性分别为73．00％，66．70％，87．24％。结论高频超声检查可作为乳头溢液性病变的首选方法，为临床制定合理的治疗方案能够提供重要的参考依据。     

Value of mammography and breast ultrasound in male patients with nipple discharge

Objective

To assess the contribution of mammography and ultrasound in men with nipple discharge.

Materials and methods

All men with nipple discharge who underwent mammography and/or ultrasound between 1993 and 2011 in our hospital were retrospectively evaluated. Radiological findings were classified according to BI-RADS lexicon. The final diagnosis was made based on histopathological results or clinical–radiological follow-up. The diagnostic performance of physical examination, mammography and ultrasound was calculated and compared.

Results

26 men with 21 mammograms and 19 ultrasounds were reviewed. The final diagnoses were: 6 carcinomas (23.1%), 10 gynaecomastias, 2 pseudogynaecomastias and 8 normal breast tissues. Mammograms and ultrasounds performed on all five patients with infiltrating carcinoma showed a mass (categories 4 and 5). In all these patients except one, a breast mass was also noted and the physical examination was positive or suspected malignancy. In the patient with carcinoma in situ, the only conspicuous clinical sign was bloody nipple discharge and the mammography showed calcifications (category 4) that were not visible on ultrasound. Radiological findings of all patients without malignancy were classified as categories 1 and 2. The diagnostic performance of physical examination was lower than mammography and ultrasound (P > 0.05). Mammography was more sensitive than ultrasound (100% vs. 83.3%). Both techniques showed the same specificity (100%).

Conclusions

Men with nipple discharge have a high incidence of breast carcinoma. Nipple discharge may be the only clinical sign of carcinoma in situ. Mammography and ultrasound are useful in the evaluation of men with nipple discharge, diagnosing carcinoma in initial stages, avoiding unnecessary biopsies.     

乳腺导管造影对乳腺溢液性疾病诊断的临床价值

目的:探讨乳腺导管造影对溢液性乳腺疾病的诊断价值,提高其X线诊断与鉴别诊断水平。方法:回顾性分析39例乳头溢液患者的临床、影像及病理资料。结果:39例患者46个病灶乳头溢液患者中纤维腺瘤5个,乳腺癌6个,导管内乳头状瘤12个,纤维囊性乳腺病及小叶增生5个,误诊1例,乳腺癌诊断准确率为85.7%。结论:乳腺导管造影术是诊断溢液性乳腺疾病的有效方法,对其诊断与鉴别诊断有很重要的价值,可为临床提供可靠的诊断治疗依据。     

乳腺专用磁共振成像与超声对乳头溢液患者诊断价值的比较研究

目的 评估乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)对乳头溢液患者的诊断价值,并与超声比较.方法 收集行超声及乳腺专用磁共振检查共55例乳头溢液患者资料,在BI-RADS分类基础上对图像特点进行回顾性分析,并和病理学结果对照.结果 55例患者中13例为恶性肿瘤,42例为良性肿瘤.DBMRI对13例恶性肿瘤中的12例做出正确的诊断,误诊1例.超声正确诊断9例恶性肿瘤,漏诊及误诊4例.DBMRI误诊5例良性肿瘤,无漏诊,超声误诊3例良性肿瘤,漏诊4例.DBMRI对乳头溢液患者诊断的灵敏度、特异度、阳性预测值、阴性预测值、假阳性率和假阴性率分别为92.3％、88.1％、70.6％、97.4％、11.9％和7.7％,超声分别为69.2％、92.9％、75％、90.7％、7.1％和30.8％,DBMRI与超声ROC曲线下面积(AUC)分别为0.93和0.79.结论 与超声检查相比,DBMRI对乳头溢液患者病灶的检出及诊断更有优势,可以为临床提供更有价值的诊断信息.     

The diagnostic value of diffusion weighted imaging in patients with meningioma

Purpose

This study aims to determine the use of diffusion-weighted (DW) magnetic resonance imaging (MRI) in differentiating typical and atypical meningiomas.

Patients and methods

In total, 31 patients aged 37–77 years with meningiomas were included in this study. Using routine MRI sequences, the meningiomas were diagnosed and DW images were performed using factor of b-0 and b-1000. Apparent diffusion coefficient (ADC) values were measured in the lesion, in the normal area of brain parenchyma. Student t-test was used for statistical analysis. P < 0.05 was considered significant.

Results

Showed that the mean ADC of atypical/malignant meningiomas (0.42–0.69 × 10⁻³ mm²/s; P < .0001) was significantly lower compared with benign meningiomas (0.72–1.5 × 10⁻³ mm²/s). Mean NADC ratio in the atypical/malignant group (0.61) was also significantly lower than the benign group (1.21; P < .0001), without overlap between groups. The difference between the ADC values of the subtypes of typical meningiomas was insignificant.

In conclusion

Typical meningiomas have higher ADC values than atypical cases. DW MRI may be of help in differentiating typical and atypical meningiomas.