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。     

纤维乳管镜检查乳头溢液应用体会

乳头溢液是乳腺疾病中较常见且较重要的症状之一,约10%的女性在乳腺常规检查时被发现有乳头溢液[1].多数乳头溢液是乳管内病变的早期表现.以往大多采用乳腺彩色超声多普勒、乳管造影检查、溢液涂片细胞学检查、细针穿刺细胞学检查以及活组织病理检查等方法进行诊断,由于不能直观反映病变情况,确诊率低.20世纪90年代以来,纤维乳管镜(6beroptic ductoscopy,FDS)在临床上的成功应用,成为乳头溢液患者一种全新的检查方法.     

纤维乳管镜检查乳头溢液30例初步体会

乳头溢液在各种乳腺疾病中的发生率约为3%~8%[1]。以往对乳头溢液缺乏有效的检查手段,我院新引进了德国铂立纤维乳管内视镜(fiberoptic ductoscopy,FDS),它无创伤,可以直视溢液乳管的病变,具有较好的诊断价值。2006年7月至10月对30例乳头溢液患者行FDS检查,报告如下。临床资料1.一般资料:30例均为女性,平均年龄36岁。其中按溢液乳孔数目分为单孔溢液18例,双孔/多孔溢液12例。按乳头溢液颜色分为乳白色溢液3例,无色浆液性溢液8例,黄色浆液性溢液8例,血性溢液11例。本组患者体检均未触及明显乳房肿块。2.仪器:德国POLYDIAGNOSI公司的…     

275例乳管内镜的临床应用

目的评价纤维乳管镜对乳头溢液的诊治作用。方法应用MF2-707型乳管内镜对275例乳头溢液患者进行诊治。结果275例病例中,乳腺导管内癌有10例,乳头状瘤病有15例,导管内乳头状瘤有80例,乳腺导管炎有54例,乳管扩张症有113例,3例诊断为正常乳管。部分乳腺导管炎及乳管扩张症患者经药物冲洗后症状消失。结论乳管内镜检查是一种对乳头溢液患者安全、有效的检查及治疗方法。     

纤维乳管镜的应用

乳头溢液 (Nippledischarge)发生率约 3%～ 8% ,其中导管内乳头状瘤及乳头状瘤病占 35 %～ 4 8% ,乳腺癌占 1 0 %～ 1 5 % [1 ] 。乳头溢液是早期乳腺癌的重要征象 ,甚至是唯一的临床表现。尽管乳头溢液以往的诊断方法很多 ,但由于诊断率不高 ,无法早期诊断和及时治疗。 2 0世纪 90年代发展起来的纤维乳管镜 (Fiberopticductoscopy,FDS)检查 ,使乳头溢液的诊断治疗有了突破性进展。它不仅有助于导管内微小病变的早期诊断 ,还有利于导管内病变的微创治疗[2 -5] 。现就FDS的有关问题综述如下。　　一、乳管镜的发展史为能直视下观察乳管内…     

乳管镜在乳头溢液疾病诊断中的应用

目的 报道乳管镜在以乳头溢液为主要症状的乳腺疾病诊断中的临床应用。方法2003年10月至2004年9月对169例乳头溢液患者行乳管镜检查和随访。结果发现乳管炎79例，导管内乳头状瘤62例，导管内乳头状瘤恶变或导管内癌9例，未见异常19例。随访发现，导管内乳头状瘤、导管内乳头状瘤恶变或导管内癌的乳管镜诊断率分别为89．8％（44／49）、55．6％（5／9）。仅1例检查后第2天出现患侧乳房疼痛及轻度潮红，口服抗生素3d后痊愈。结论乳管镜检查是惟一可直视下诊断乳头溢液的检查方法，它直接、安全、有效、准确性较高，是乳头溢液疾病诊断及治疗的新方法。     

乳管镜下乳管内非隆起性病变的诊断和治疗

目的 探讨乳管镜对乳管内非隆起样病变的诊断价值。方法 回顾性分析2002年12月～2005年10月165例乳管内非隆起样病变的病变特点,形态特征及治疗效果。结果 165例乳管内非隆起性病变中,浆细胞性乳管炎135例,慢性囊性乳腺病18例,乳管炎12例。非手术治疗144例,症状完全缓解82例,好转62例;手术治疗21例浆细胞性乳管炎。结论 乳管镜是诊断乳管内非隆起样病变的重要手段,同时还可以借助乳管镜对此类病变进行有效的治疗,使大多数患者避免不必要的手术。     

乳管镜技术临床应用及其诊疗价值

乳管镜技术在乳腺疾病诊断及治疗技术发展过程中具有划时代的意义,其基本解决了乳头溢液这个临床常见症状难以诊断的问题,并对临床进一步治疗具有重要的指导价值.从1988年首次进行乳管镜检查以来,其技术不断发展完善,已经在临床得到了广泛的应用.现就乳管镜的应用适应证及其诊疗价值展开讨论.     

乳管镜诊治乳头溢液290例分析

乳头溢液是乳腺疾病常见的三大症状之一,发生率约为3%～8%[1],多数乳头溢液是乳管内病变的早期表现,以往多采用乳管造影、溢液涂片细胞学检查,由于不能直接反映病变情况,因此确诊率低。自1988年首次进行乳管镜检查以来,技术不断发展完善,已经在临床得到广泛应用[2]。淄博市妇幼保健院乳腺外科2006年3月—2009年12月应用乳管镜检查乳头溢液患者290例,总结报道如下。     

中国乳管镜临床实践指南（2024版）

<正>乳管镜的发明使得人类首次直接观察乳腺导管内发生的病变。1998年,Teboul等用外径为1.7 mm的硬性内镜,在超声探头的引导下成功地观察到了乳腺导管腔,开创了乳腺导管内镜检查的先河^[1]。1989年Makita等^[2]对Teboul的硬管内镜进行改良,使其外径缩小为1.25 mm,并首先成功对16例乳管内的病灶进行了非直视下的活检。1991年Okazaki等^[3]与藤仓(Fujikura)株式会社共同研发了纤维乳管镜,并使乳管镜外径缩小至0.72 mm。1997年国内多家医院在国内引进了此项技术,解决了乳头溢液病因诊断和乳管内病变定位等临床难题^[4-6]。     

纤维光导乳管镜用于乳头溢液的诊断

目的　评价纤维光导乳管镜检查对乳头溢液的诊断价值。方法　应用三菱公司FV 2 0 0 0E型半硬性纤维光导乳管镜检查系统 ,对 2 6 9例乳头溢液进行诊断 ,并与术后病理诊断作对比分析。结果　 2 6 9例患者中发现乳管内占位性病变 12 9(48% )例 ,其中单发病变 92 (71 3% )例 ,多发病变2 7(2 0 9% )例 ,弥漫性病变 10 (7 8% )例 ,镜下诊断导管内乳头状瘤 12 5 (96 9% )例 ,恶性病变 4 (3 1% )例。镜下诊断乳头状瘤与病理诊断符合率为 91 9% ,与乳腺癌的诊断符合率为 75 %。另外 14 0(5 2 % )例诊断为非肿瘤性良性疾病 ,主要为乳腺导管扩张症、乳管炎。结论　纤维光导乳管镜检查乳头溢液准确、可靠。     

Breast duct microendoscopy in nipple discharge: microbrush improves cytology

Background Breast duct microendoscopy is a new technique that allows direct visualization of the mammary ductal epithelia and has the potential to provide greater accuracy in the diagnosis of benign and malignant breast conditions. We have already established the feasibility of BDME on mastectomy specimens and in patients both under general and local anesthesia. It was the aim of this study to investigate the use of BDME in patients with pathological nipple discharge and to explore the feasibility of using an endoluminal microbrush to take cytology samples from specific lesions. Materials and methods Breast duct microendoscopy was offered to all patients undergoing surgery for nipple discharge. Surgery included microdochectomy (younger women) and total duct excision (especially in postmenopausal women). The microbrush was used to collect samples whenever an endoluminal papilloma was seen on endoscopy. The results of microbrush cytology samples were compared to ductal lavage samples. Results Fifty consecutive patients undergoing microdochectomy or total duct excision for nipple discharge had breast microendoscopy (28 general, and 22 under local anesthesia). Thirty-one patients had microdochectomy and nineteen had total duct excision. Visualiza- tion of discharging ducts was accomplished in 100% cases. Endoluminal abnormalities were seen in 33 (66%) patients and dilated ducts were seen in 17 patients. Among the 33 patients, 15 had single papilloma, 3 multiple papilloma and 15 inflammation (erythema, fronds, adhesions). Seven out of eight patients with an intraductal papillorna who had microbrush cytology showed papillary cells whereas only 2 out of 11 patients who had ductal lavage were positive for papillary cells. Thus the sensitivity of the brush cytology technique for the diagnosis of papilloma was 87.5% and the sensitivity of ductal lavage 18% (p = 0.0055). Conclusion Breast duct microendoscopy is an effective way of establishing the etiology of nipple discharge. The microbrush increases the sensitivity of cytology significantly.     

Routine operative breast endoscopy for bloody nipple discharge

Background Submillimeter endoscopes are now available and have been described to assist surgeons in the evaluation and management of symptomatic nipple discharge. Methods To evaluate its potential use, a microendoscope (0.9 mm Acueity) was used on all patients in a single surgeon's practice who were undergoing nipple exploration for spontaneous hemoccult positive nipple discharge. This procedure was performed at the surgical resection of the symptomatic retro-areolar duct, and 27 patients underwent the endoscopy during the period from January 2000 to August 2001. Results In 96% (26 of 27) of the patients, the endoscope was successfully introduced into the lactiferous sinus, and the proximal breast ducts were successfully visualized. A lesions accounting for the bleeding was seen in all 26 patients, with 70% (n=19) having multiple intraluminal defects. Cancers were identified in two cases (7.4%), and in both cases, there was a more proximal papilloma in the same ductal system. Similarly, in 33% of the benign cases, both papillomas and usual or atypical ductal hyperplasia were present. Lesions were identified that extended up to 7.5 cm deep to the nipple. The deepest lesions was one of the endoscopically identified cancers in a patient with normal mammogram and breast ultrasound. Surgical resection could be directed by simple transillumination of the skin during endoscopy. Conclusions This series demonstrates the clinical feasibility of routine operative breast endos-copy in the management of bloody nipple discharge. The high incidence of multiple lesion identification suggests that the classic blind resection of a limited distance of duct in the retroareolar space may significantly underestimate the true extent of proliferative disease accounting for pathologic nipple discharge.     

乳管镜在乳头溢液疾病中的临床应用

目的探讨纤维乳管镜在乳头溢液疾病中诊断和治疗的应用价值。方法对2006年3月至2007年3月在我院行纤维乳管镜检查及冲洗的27例患者的临床资料进行回顾性分析。结果27例患者中,乳管镜诊断为乳管内乳头状瘤12例（其中1例为导管原位癌）,乳头状瘤病5例,乳管扩张及乳管炎共8例,未见明显异常2例。乳管内乳头状瘤和乳头状瘤病的镜下诊断与病理诊断符合率分别为91．7％（11／12）和80．0％（4／5）。结论纤维乳管镜可在直视下对乳头溢液疾病进行检查和冲洗,诊断准确率较高,是临床上对乳头溢液疾病进行诊断和治疗的可靠方法。     

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。     

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目的探讨病人年龄、乳头溢液的性状、乳房肿块等临床因素与乳头溢液性疾病良、恶性的关系。方法对2001年1月至2004年1月收治的265例乳头溢液病例进行回顾性研究。乳腺癌38例,占143%;乳腺良性疾病227例,占857%;采用单因素和多因素分析病人年龄、溢液的性状、乳房肿块等因素与溢液良恶性的关系。结果(1)单因素分析年龄>50岁乳头溢液者患乳腺癌明显高于≤50岁伴乳头溢液者(P<005);血性溢液者患乳腺癌的明显高于其它性状溢液者(P<005);溢液伴乳房肿块者患乳腺癌明显高于不伴乳房肿块者(P<0001)。(2)多因素分析,年龄>50岁、血性溢液、伴有乳房肿块是患乳腺癌的高危因素(z值>6,P<005)。(3)对不伴乳房肿块乳头溢液多因素分析显示年龄>50岁、血性溢液是乳腺癌高危因素(z值>6,P<005)。结论病人年龄和乳头溢液性状对鉴别溢液良、恶性质具有重要临床意义。     

乳管内窥镜在乳头溢液中的临床应用200例

目的 评价乳管内窥镜对乳头溢液诊治的作用。方法 应用FVS-3500乳腺纤维导管系统对200例乳头溢液患者进行诊治。结果 本组200例,共210个溢液孔,插人204个孔,成功率达97.0%。本组发现早期乳腺癌9例（4.5%),乳头状瘤63例（31.5%),乳头状瘤病3例（1.5%),导管扩张或伴炎症96例（48.0%),“正常”导管29例（14.5%）。活检吸出肿块10例,导管慢性炎症灌注药物冲洗治愈25例,手术患者共67例,经病理证实符合率达95.0%,乳头溢液涂片检查阳性率仅为乳管内窥镜的1/3。结论 乳管内容均匀是可插入到4级乳腺导管,能早期诊断乳腺癌,对部分乳头状瘤和导管慢性炎症可以作介入治疗,在乳腺外科中有广泛应用前途。     

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.     

乳管造影在诊断乳头溢液中的价值

目的评价乳管造影的应用价值.方法分析1998年1月至2000年5月间入院的51例乳头溢液患者的乳管造影结果和病理学检查结果.结果乳管造影对乳头溢液有较高的诊断价值,敏感性为84.3%.结论乳管造影可对病变作出定位和定性诊断,特别有利于诊断多发病变和乳腺边缘病变,但不能代替病理学检查.     

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.