乳腺导管镜的临床应用

目的 评价乳腺导管镜在乳头溢液诊疗中的临床意义。方法 用FV—3000型MS—611E乳腺导管镜对31例乳头溢液病人进行检查，并对检查情况加以分析。结果 乳腺导管镜诊断为乳腺增生及导管扩张13例，导管内乳头状瘤17例，乳腺癌1例。乳腺导管镜检查与术后病理的诊断符合率为91．6％(22／24)。结论 乳腺导管镜可以对乳头溢液病人作出明确的诊断和定位，是乳腺疾病诊治中的一种有效手段。     

乳腺导管扩张症的外科治疗

目的探讨乳腺导管扩张症的外科治疗。方法收集我院1991年9月~2006年5月乳头溢液或乳房肿块就诊病例,经手术后证实为乳腺导管扩张症者58例,行病变导管切除或乳房区段切除术。结果经手术治疗,病人乳房无变形,随访观察无复发。结论手术治疗乳腺导管扩张症效果较好。     

彩色多普勒超声与乳腺纤维导管镜联合应用对乳头溢液的诊断价值

乳头溢液是乳腺疾病的常见症状之一,在乳腺疾病诊断中彩超成为一种常用甚至常规的检查方式,而乳管镜能够直视下对溢液乳管进行检查,具有高敏感性、定位准确等特点,已成为导管内疾病的最理想的诊断手段[1]。     

乳管冲洗、药物灌注治疗良性乳头溢液(附46例分析)

乳头溢液是乳腺导管恶、良性疾病的共同临床表现.恶性者必取手术疗法;良性者取手术治疗多数难被病人接受,但非手术治疗又很难使其获愈.我院自1987年起,在乳腺导管造影的启发下,对诊断明确的乳头良性溢液疾病,采取向乳腺导管内注入生理盐水冲洗后,再灌注抗生素的治疗方法.截止1991年底共治疗46例良性乳头溢液病人,效果满意.本文介绍了乳管冲洗、药物灌注的方法;并结合临床效果,讨论了谈法的适应证及治疗中的一些问题.     

纤维乳管镜在乳腺导管肿瘤诊断中的应用价值

目的探讨纤维乳管镜对乳腺导管肿瘤的临床诊断价值。方法局麻后，先用Boumann眼科泪管探针扩张溢液乳管，用FVS-3000纤维乳管镜检查溢液乳管，发现病灶后用活检钳取活组织进行病理检查。结果165例乳管内肿瘤，乳管镜诊断乳头状瘤、乳头状瘤病和导管内癌的诊断符合率分别为99．2％（126／127）、87．5％（14／16）、86．4％（19／22）。22例导管内癌，一、二、三、四级乳管分布分别为50．0％（11／22）、27．3％（6／22）、13．6％（3／22）和9．1％（2／22）。结论纤维乳管镜对乳腺导管肿瘤的诊断有较高的临床价值。检查时要重点注意乳头周围的乳腺导管，对终末导管也不能忽视。     

纤维乳管镜的临床应用

目的探讨纤维乳管镜在诊断及治疗伴乳头溢液的乳腺疾病中的临床应用价值。方法利用纤维乳管镜FVS-3000系统对504例乳头单孔溢液患者进行检查，并对资料进行回顾性分析。结果504例乳头溢液患者中，乳腺导管扩张症56例，乳腺炎101例，乳管内乳头状瘤（病）280例，乳腺癌29例，泌乳症8例，30例未发现异常者列为正常。手术治疗309例。纤维乳管镜对乳管内乳头状瘤（病）的诊断符合率为77％，对乳腺癌的诊断符合率为83％。结论纤维乳管镜对乳头溢液患者是一种有效而又安全的检查方法。     

纤维乳管镜对乳头溢液患者的诊断价值——附104例报告

目的 评价纤维光导乳管镜检查对乳头溢液的应用价值. 方法 应用德国Scholly Fiberoptic GmbH 42.0500型半硬性纤维光导乳管镜检查系统对104例乳头溢液进行诊断,并与术后病理诊断作对比分析. 结果 104例均成功检查.对乳管内占位性病变的检出率94%（49/52）.乳管镜诊断乳腺导管癌的敏感性为50%（1/2）,特异性为91%（43/47）,阴性预测值为98%（43/44）,阳性预测值为20%（1/5）,准确性为90%（44/49）.乳头状瘤病镜下诊断5例,其中3例与病理诊断符合,符合率60%;另2例为多发性乳头状瘤,均行腺叶切除.镜下诊断乳头状瘤38例,均行含病变乳管的腺叶部分切除术.55例乳管炎性疾病未行手术,3例（3%,3/104）因继续溢液行乳管镜复诊检出先前漏检之乳头状瘤后经手术证实. 结论 乳管镜能明确乳头溢液病因,确定病变部位,是乳头溢液的首选检查方法;使乳管炎与乳管扩张症免于手术.     

纤维乳管镜临床应用新进展

目的 介绍纤维乳管镜在乳腺疾病的临床应用现状、价值及发展前景。方法 综述纤维乳管镜在乳腺疾病临床应用的研究进展。结果 纤维乳管镜在乳腺疾病尤其是伴乳头溢液者应用广泛，已显示出较乳管造影等常规检查方法更高的诊断准确率，且可同时行乳管冲洗和镜下定位、活检、治疗。结论 纤维乳管镜具有较高的诊断和治疗价值，是一种很好的内镜技术，相信能被更好地应用和发展。     

乳管镜对乳腺导管内疾病的诊断及介入治疗--附100例临床分析

目的:探讨乳管镜在乳腺疾病诊断和治疗中的作用.方法:应用乳腺纤维导管内视镜对100例伴乳头溢液的乳腺导管性疾病进行诊断或介入治疗.结果:13例导管内占位性疾病得到了正确诊断,87例渗出性导管病经治疗后治愈.结论:乳管镜对乳管内病变的正确诊断及手术方式可提供依据,并可对渗出性病变进行介入治疗.     

溢液乳腺疾病乳腺导管造影表现与病理(附105例分析)

目的分析溢液乳腺疾病的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法对临床表现为乳头溢液并经手术、病理证实的溢液乳腺疾病105例,包括乳腺癌12例、导管内乳头状瘤38例、乳腺导管扩张症43例及12例乳腺囊性增生病,回顾性分析其乳腺导管造影的影像表现及病理特征。结果本组乳腺导管造影正确诊断乳腺癌11例,导管内乳头状瘤35例,乳腺导管扩张症41例,乳腺囊性增生病12例。乳腺癌主要造影表现：导管内充盈缺损,管壁浸润;＂潭湖征＂;导管结构紊乱;管壁不规则伴微钙化灶;乳头状瘤病伴导管壁毛糙破坏,提示恶变。单发导管内乳头状瘤造影表现为大导管内边缘光滑的充盈缺损,导管边缘光整;多发者表现为小分支导管内多发边缘光滑之充盈缺损。乳腺导管扩张症造影表现：大、中、小导管同时不同程度地扩张,或伴有管壁毛糙,分支导管萎缩变形等炎症表现。乳腺囊性增生病中囊肿表现为小导管高度扩张形成囊袋状改变,盲管腺病表现为小导管或末梢导管呈多发小囊袋状改变。结论乳腺导管造影对溢液性乳腺疾病是一项安全而有效的检查方法,对乳腺导管内占位性病变的定性、定位诊断具有高度价值,对导管扩张症、乳腺囊性增生病等疾病亦能作出较准确的诊断。     

A review of mammary ductoscopy in breast cancer

Breast carcinoma and hyperplasia are thought to start in the lining of the breast duct. Mammary ductoscopy is an emerging technique allowing direct visual access of the ductal system of the breast through the nipple. This article reviews and discusses the utility of mammary ductoscopy. Abnormalities can be identified successfully by mammary ductoscopy, and intraductal biopsy can be used when the tumor is a polypoid type. Ductal lavage using microcatheters is effective in identifying malignant cells in high-risk women and this has stimulated interest in exploring the role of mammary ductoscopy in breast cancer screening. Mammary ductoscopy combined with ductal lavage may have a role in the management of patients with nipple discharge, the guiding of breast-conserving surgery for cancer, and in screening for high-risk women. The addition of molecular and genetic analysis of cells obtained by mammary ductoscopy are likely to enhance the use of this technique. Mammary ductoscopy techniques are safe and appear useful for detecting abnormalities in the breast. The additional molecular biologic study or ductal lavage may enhance the ability to direct and limit subsequent surgery when removing the offending lesions.     

The clinical applications of mammary ductoscopy

BACKGROUND: Mammary ductoscopy (MD) is a newly developed endoscopic technique that allows direct visualization and biopsy examination of the mammary ductal epithelium where most cancers originate. The procedure can be performed under local anesthesia in the office setting. This article reviews the rationale, current clinical applications, and limitations of MD. METHODS: A literature search was performed using Pubmed for indexed articles published over the past 30 years using the key words "mammary ductoscopy," "breast ductoscopy," "ductal lavage," and "nipple aspiration." The most important articles were analyzed and discussed. RESULTS: MD is a useful diagnostic adjunct in patients with pathologic nipple discharge. Furthermore, it can reduce the number and extent of duct excision surgeries for pathologic nipple discharge. There is a clear need to design prospective clinical trials that evaluate the potential role of MD in breast cancer screening, guiding risk-reducing strategies, and as an adjunct to breast-conservation surgery. CONCLUSIONS: MD is useful in the management of PND, but its potential role in the early detection or management of breast cancer requires further investigation.     

纤维乳管镜诊断乳头溢液的临床价值

目的：评价纤维乳管镜在乳头溢液中的诊治价值。方法：1999年3月-2005年6月，对2608例乳头溢液的病例运用了纤维乳管镜检查，直接观察溢液导管内的病变，初步判断其疾病性质并准确定位；将溢液性质、检查结果、手术病理结果进行总结分析。结果：2608例乳头溢液病例中，溢液为乳白色者97例，无色者563例．黄色者l075例，血性者873例。纤维乳管镜拟诊为“导管扩张”361例，慢性炎症596例，乳管内乳头状瘤（病）l609例．乳腺癌42例；并对其中1444例进行了手术。纤维乳管镜对乳管内乳头状瘤（病）的诊断符合率为78．09％，对乳腺癌的诊断符合率为90％。结论：纤维乳管镜具一定的诊断准确性和定位可靠性，对乳头溢液病人是一种安全有效的初步检查方法。对具无色、黄色或血性溢液的病人均应行纤维乳管镜检查。     

Spontaneous unilateral nipple discharge: when screening tests are negative--a case report and review of current diagnostic management of a pathologic nipple discharge

We describe a 45-year-old woman who presented with a spontaneous unilateral nipple discharge. With a negative breast examination and screening tests (mammography and ultrasonography) she underwent mammary ductography, which revealed a small 3-4 mm intraluminal filling defect. A core biopsy showed high-grade ductal carcinoma in situ (DCIS). An attempted wide local excision was unsuccessful, and the patient underwent a mastectomy. Pathologic assessment revealed high-grade DCIS and multiple foci of invasive mucinous ductal adenocarcinoma. Rare tumor cells were identified in the subcapsular sinuses in both sentinel lymph nodes. We report this case to point out the importance of the diagnostic examination for patients with a pathologic nipple discharge and review current and possible future diagnostic management.     

Feasibility and Technical Considerations of Mammary Ductoscopy in Human Mastectomy Specimens

Abstract: Recent advances in endoscopic technology have made visualization of human mammary ducts possible. The purpose of this study was to assess the feasibility and technical factors influencing the ability to successfully visualize the epithelium of the human mammary ductal system. Lacrimal duct probes were used to dilate nipple orifices to 1.2 mm on 42 mastectomy specimens. The Depth of Field Imaging Micro-Minimally Invasive (DOFI® MMI) system consisting of a 1.2 mm rigid ductoscope with a 350 μm working channel was introduced into mammary ducts under air insufflation or saline irrigation. At least one major duct could be dilated and cannulated in all 42 specimens. Visualization of the proximal duct was accomplished in 34 of 42 (81%) specimens, whereas more extensive navigation through the distal subsegmental ducts was achieved in 22 of 42 (52%) specimens. Ductoscopy into the terminal ducts was accomplished in all patients with a previous history of nipple discharge or discharge at the time of the procedure (10 of 10). In three patients with no history of nipple discharge prior to ductoscopy, incidental papillomas were discovered and confirmed by the pathologist. In conclusion, mammary ductoscopy is technically feasible and may have an application as an additional diagnostic modality for patients with pathologic nipple discharge.     

Mammary Ductoscopy and Ductal Washings for the Evaluation of Patients with Pathologic Nipple Discharge

Abstract:  The majority of breast diseases result from lesions of the ductal epithelium. Mammary ductoscopy allows for visualization of intraductal abnormalities, and ductoscopic lavage provides thousands of cells for analysis. We reviewed our experience of 89 cases of patients with pathologic nipple discharge (PND) undergoing ductoscopy-directed duct excision and collection of ductal washings. Patients undergoing ductoscopy-directed duct excision with ductal washings had an 88% abnormal pathology rate. Most abnormalities were benign (71% papillomas), but the atypia rate for this group was 62%. The combination of visualization and pathologic analysis of washings provided the highest predictive value for the diagnosis of papilloma. Cellular yields for this technique were excellent with most specimens yielding >5,000 epithelial cells per high powered field and with evaluable ductal cells in 82% of specimens. Mammary ductoscopy offers the advantage of a high lesion localization rates with intraoperative guidance. The most accurate tool was the combination of ductal washings and ductoscopic visualization, but preoperative use of these techniques is not helpful in most cases. Greater than 90% of patients with PND are found to have a lesion on pathologic examination when using this technique for directed duct excision. Of interest, ductal washings obtained from symptomatic patients with benign diseases are often atypical.     

乳管镜治疗乳腺导管内渗出性疾病的临床分析

目的探讨乳管镜治疗乳腺导管内渗出性疾病的效果。方法应用乳腺纤维导管内视镜对72例80侧伴乳头溢液的乳腺导管性疾病进行诊治，在镜下确诊后生理盐水反复冲洗至絮状物消失，退镜时做管内置药（地塞米松5mg和庆大霉素4万U）治疗。结果镜下诊断导管炎57侧，导管扩张症23侧。65侧痊愈（溢液完全消失，半年未复发），随访1～2年，无复发；15侧好转（溢液显著减少，半年内虽有少量溢液，但呈进行性减少，或偶见内衣湿渍，但未见液体溢出）。结论乳管镜对乳管内渗出性病变进行局部治疗效果良好。     

The role and limitations of mammary ductoscope in management of pathologic nipple discharge

Mammary ductoscope allows visualization of the breast ductal wall and sampling of the abnormal area for diagnostic purposes. We are reporting our center experience in application of mammary ductoscope in detecting the underlying etiology of pathologic nipple discharge. Between November 2005 and December 2006 a total of 54 women, with spontaneous persistent nonlactational unilateral uniductal nipple discharge of no palpable lesions and negative breast sono-mammography, were included in the study for morphologic assessment of ductal epithelium, ductal lavage and ductoscopically guided procedures as punch biopsy and ductoscopically guided microdochectomy. Forty-one patients (76%) with nipple discharge were positive ductoscopically. Thirteen patients (24%) appeared normal. Ductoscopic lavage has a much more cellular yield than ordinary squeezing cytology. Ductal thickening by the ductoscope (11 cases) revealed to be hyperplasia on pathology (five cases), papilloma (two cases), atypical ductal hyperplasia (two cases), ductal carcinoma in situ (one case), and invasive breast carcinoma (one case). There was a significant association between intraductal visual observations and histopathologic diagnosis. Mammary Ductoscope is a promising tool in management of pathologic nipple discharge. Biopsy and ablation techniques can be performed during ductoscopy with correlation between visual findings and histopathology, but there are still some limitations of in clinical practice.