乳管造影与纤维乳管内镜对乳头溢液诊断价值的比较

目的：通过乳管造影与纤维乳管内镜的比较,探讨乳头溢液的诊断方法。方法：对2007年-2009年48例单侧乳头溢液患者同时行乳管造影及纤维乳管内镜检查,结果进行对照分析,同时与病理结果相比较。结果：乳管造影诊断为乳管内隆起性病变28例,表现为充盈缺损、中断或移位等,纤维乳管内镜（FDS）诊断乳管内乳头状瘤28例,乳腺癌2例,余为非隆起性病变。两种检查同时为阳性诊断25例,同为阴性诊断15例,不一致者为8例。结论：两种检查在乳管内隆起性病变的阳性检出率差异无统计学意义。就检查而言,两种方法各有千秋,阳性率基本一致,结合定位及治疗,FDS更有优越性。     

Mammary duct ectasia in infant breast with bloody nipple discharge: sonographic findings

Bloody nipple discharge is very rare in childhood. We report the sonographic findings of mammary duct ectasia and cystic changes under the nipple with abnormal content involving a 3-month-old boy with bloody nipple discharge.     

乳管镜在无乳头溢液患者中的诊断价值

目的探讨乳管镜在无乳头溢液乳腺病患者中的诊断价值。方法对165例无乳头溢液乳腺病患者进行乳管镜检查，并对有异常发现者进行手术切除和病理组织学检查。结果165例患者行乳管镜检查，9例未见异常，45例为乳管扩张症，84例为乳管炎症，6例为乳管内乳头状瘤，18例为乳管内乳头状瘤病，3例为导管内癌。乳管镜诊断与病理诊断的符合率为64．1％。结论对于无乳头溢液乳腺病患者，乳管镜有一定的临床诊断价值。     

Prevalence of bacteria in the nipple discharge of patients with duct ectasia

The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.     

选择性乳腺导管造影对溢液性导管癌的诊断价值

目的探讨选择性乳腺导管造影对溢液性导管癌诊断价值,旨在为临床提供可靠的诊断依据。方法回顾性分析21例乳头溢液(血性、浆液性、血性及浆液性交替、清水性)导管癌患者的乳腺钼靶X线平片及导管造影X线表现,并经临床或手术病理证实。结果乳腺钼靶X线平片正常10例,平片见肿块及钙化11例,选择性导管造影X线表现:大导管及分支导管管壁不规则浸润、僵硬、狭窄及截断征象和导管束状结构是癌侵犯、收缩或压迫等引起的改变。结论选择性乳腺导管造影对溢液性导管癌诊断中具有重要价值,为临床提供可靠的诊断依据,提高早期导管内癌的检出率。     

超声对乳头溢液性病变的诊断价值

目的:探讨高频超声探头对乳头溢液性病变的应用及诊断价值。方法:用7.5MHz电子线阵探头对32例乳头溢液患者进行乳腺超声检查,记录病变部位及导管或腺体内异常,同时常规行乳腺专科查体和钼靶X线检查,诊断结果与术后病理对照比较。结果:32例中导管内病变27例、导管外病变4例、囊性增生1例。超声对乳头溢液性病变的检出率为90.6%,诊断符合率为75.9%,与钼靶X线的检出率(37.5%)比较有显著性差异(P<0.05),尤其对导管内病变更显著。结论:超声可作为乳头溢液性病变尤其是导管内病变的无创性首要检诊手段。     

非哺乳期乳头溢液病人行乳管内镜检查的护理配合

[目的]探讨乳管内镜检查在非哺乳期乳头溢液病因诊断中的应用,总结乳头溢液病人行乳管内镜检查的护理配合.[方法]对216例乳头溢液的病人行乳管内镜检查,并在直视下对乳腺导管内病变进行诊断.[结果]经采取积极的护理配合,均顺利完成检查,无并发症.本组216例中,正常乳管19例,乳管扩张30例,乳管炎症116例,乳管新生物20例,导管内瘤18例,乳头状瘤8例,导管癌5例.[结论]乳管内镜对非哺乳期乳头溢液的病人进行检查具有不易损伤乳腺导管且较其他检查方法更直观、有效、准确率高等.     

无乳头溢液导管内乳头状瘤的超声图像特征分析

目的 总结无乳头溢液导管内乳头状瘤的超声图像特征.方法 回顾性分析我院62例(73个病灶)经病理确诊的导管内乳头状瘤超声图像,根据有无扩张导管、结节,以及扩张导管与结节的关系将病灶分为Ⅰ～Ⅴ型5型,分析各型声像图特点.结果 73个病灶中,Ⅰ型27个,Ⅱ型11个,Ⅲ型30个,Ⅳ型3个,Ⅴ型2个;超声对各型的诊断准确率分别...     

乳头内陷护理研究进展

介绍了乳头内陷的病因、分类、不良后果及矫正护理方法。乳头内陷可采用手法牵引、负压吸引、挤压法、器械持续牵引、止血带固定法和外科手术等方法进行治疗．同时介绍了乳头内陷产妇母乳喂养成功的技巧。     

乳管内视镜在诊断未扪及肿块的乳头溢液中的价值

目的评价乳管内视镜在未扪及肿块的乳头溢液中的诊断价值。方法对70例未扪及肿块的乳头溢液患者同时行乳管内视镜及乳腺导管造影检查，将检查结果、溢液性质、病理检查结果进行总结分析。结果导管内隆起性病变在乳管内视镜及乳腺导管造影中的检出率分别为24．3％、31．4％，与病理诊断符合率分别为91．3％、73．9％。结论乳管内视镜可作为未扪及肿块的乳头溢液患者的首选检查方法，必要时结合乳腺导管造影，减少漏诊及误诊。     

Utility of targeted sonography in the evaluation of focal breast pain.

OBJECTIVE: To determine the utility of targeted sonography in the evaluation of patients with focal breast pain. METHODS: From January 1995 through December 1999, 110 targeted sonographic examinations were performed in 99 patients for evaluation of focal breast pain in the absence of an associated palpable mass. The sonographic, mammographic, and clinical findings were reviewed. The hospital pathology database was searched to identify any interval cancers and false-negative interpretations. RESULTS: No cancer was identified in any of the 110 examinations. Eighty-five (77.3%) of the examinations had negative findings. Cysts were identified in 15 cases (13.6%), and 3 solid masses (2.7%) were identified. Two of these 3 solid masses had biopsies and were shown to be benign, whereas the third mass was followed for 29 months without change. Most patients were premenopausal, had no family or personal history of breast cancer, and were not taking exogenous hormones. Eighty-five patients (77%) were referred by primary care physicians. CONCLUSIONS: In patients with focal breast pain without an associated palpable mass, sonography may be more useful for patient reassurance than for cancer detection.     

双侧乳腺导管内癌并乳头溢液4例临床分析

目的 探讨以乳头溢液为主要症状的双侧乳腺导管内癌临床诊疗方法.方法 回顾性分析4例双侧乳腺导管内癌合并乳头溢液患者的临床资料.结果 4例均行彩超检查,3例行乳管镜检查,2例行乳腺钼靶检查;其中1例彩超检查发现双侧肿块;1例彩超发现双侧肿块同时乳管镜发现双侧乳头状瘤样改变;1例彩超发现左侧肿块、钼靶提示双侧钙化,而乳管镜发现左侧乳头状瘤样改变;1例彩超未见肿块,钼靶提示右侧钙化,乳管镜发现双侧乳头状瘤样改变.结论 在超声基础上加行钼靶、乳管镜检查有助于以乳头溢液为主要症状的双侧乳腺导管内癌的检出.     

Contrast-enhanced power Doppler sonography in breast lesions: effect on differential diagnosis after mammography and gray scale sonography.

OBJECTIVE: To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination. METHODS: Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. RESULTS: The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively). CONCLUSIONS: Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.     

Diagnosis of the intraductal component of invasive breast cancer: assessment with mammography and sonography.

OBJECTIVE: The aim of this study was to investigate mammographic and sonographic features and their sensitivities for depiction of the intraductal component associated with invasive ductal carcinoma (IDC). METHODS: During a 1-year period, 132 patients with IDC underwent surgical treatment. All patients underwent mammography and high-resolution sonography, and the findings were reported according to the American College of Radiology's Breast Imaging Reporting and Data System lexicon. Tumors were classified as "pure IDC" and "IDC with an intraductal component" by histopathologic evaluation. We compared mammographic and sonographic features between the above 2 groups and attempted to correlate them with histopathologic findings. We also investigated separate and combined sensitivities, specificities, and accuracies of both mammography and breast sonography for showing intraductal components. Finally, imaging measurements were compared with pathologic measurements. RESULTS: One hundred four (79%) of the 132 IDCs contained an intraductal component. Patients with IDC with an intraductal component showed calcifications on mammography and showed an echogenic halo, duct dilatation, calcifications, and increased vascularity in surrounding tissue on sonography more frequently than patients with pure IDC. The sensitivities of mammography, sonography, and their combined assessment for detection of an intraductal component were 55%, 80%, and 86%, respectively. The combined assessment (r = 0.90) measured the extent of the tumor more accurately than mammography (r = 0.71) or sonography (r = 0.79) separately. CONCLUSIONS: Combined assessment with mammography and sonography offers more accurate information for the presence of an intraductal component and the extent of a tumor than each separate assessment.     

乳头溢液肿瘤标志物联合细胞学检查对乳腺癌的诊断价值

目的评价乳头溢液癌胚抗原(CEA)、糖链抗原125(CA125)及细胞学联合检测对乳腺癌的诊断价值。方法随机选择128例乳头溢液患者和40例正常分娩产妇进行乳头溢液或乳汁CEA、CA125和细胞学检查。结果乳腺癌患者乳头溢液CEA、CA125水平高于正常分娩产妇和乳腺良性病变患者(P<0.05),良性病变患者乳头溢液CEA、CA125水平高于正常分娩产妇(P<0.05);CEA、CA125或细胞学检查单独检测的诊断灵敏度低于各指标联合检测,但诊断特异度高于联合检测。结论乳头溢液CEA、CA125、细胞学检查联合检测有助于提高乳腺癌诊断灵敏度,减少漏诊率。     

Application of power Doppler vocal fremitus sonography in breast lesions.

OBJECTIVE: The purpose of this study was to illustrate the method and use of power Doppler vocal fremitus (PDVF) sonography in the detection and diagnosis of breast lesions. METHODS: One case was evaluated by various sonographic parameters and equipment to determine how the VF images were affected. Cases illustrative of a broad range of breast conditions were also collected. Each image pair consisted of B-mode and VF images to maintain an identical projection and to illustrate the influence of PDVF sonography. RESULTS: With B-mode and PDVF sonography, we evaluated and compared various breast conditions, including normal anatomic structures and abnormal lesions. We found that PDVF sonography is useful for distinguishing abnormal masses from normal tissue, such as differentiating between isoechoic tumors and isoechoic glandular tissues, and discriminating entrapped fat lobules from isoechoic tumors. Furthermore, PDVF sonography was useful for determining whether intracystic echoes are attached to the cyst wall. CONCLUSIONS: Power Doppler VF imaging is a valuable adjunct tool to B-mode sonography in the evaluation of breast lesions.     

Tissue harmonic imaging: utility in breast sonography.

OBJECTIVE: To determine the impact of tissue harmonic imaging on visualization of focal breast lesions and to compare gray scale contrast between focal breast lesions and fatty tissue of the breast between tissue harmonic imaging and fundamental frequency sonography. METHODS: A prospective study was performed on 219 female patients (254 lesions) undergoing sonographically guided fine-needle biopsy. The fundamental frequency and tissue harmonic images of all lesions were obtained on a scanner with a wideband 7.5-MHz linear probe. Twenty-three breast carcinomas, 6 suspect lesions, 9 fibroadenomas, 1 papilloma, 1 phyllodes tumor, 162 unspecified solid benign lesions, and 40 cysts were found. In 12 cases the fine-needle aspiration did not yield sufficient material. The gray scale intensity of the lesions and adjacent fatty tissue was measured with graphics software, and the gray scale contrast between lesions and adjacent fatty tissue was calculated. RESULTS: Tissue harmonic imaging improved the gray scale contrast between the fatty tissue and breast lesions in 230 lesions (90.6%; P < .001) compared with fundamental frequency images. The contrast improvement was bigger in breasts with predominantly fatty or mixed (fatty/glandular) composition than in predominantly glandular breasts. The overall conspicuity, lesion border definition, lesion content definition, and acoustic shadow conspicuity were improved or equal in the harmonic mode for all lesions.CONCLUSIONS: The tissue harmonic imaging technique used as an adjunct to conventional breast sonography may improve lesion detectability and characterization.     

Contribution of tissue harmonic imaging and frequency compound imaging in interventional breast sonography.

OBJECTIVE: The purpose of this study was to retrospectively compare conventional imaging, frequency compound imaging (CI), and tissue harmonic imaging (THI) in interventional breast sonography. METHODS: Institutional Review Board approval and patient informed consent were not required. The authors reviewed 104 sonographically guided breast procedures in 83 patients. For each biopsy, 4 images obtained with conventional imaging, frequency CI at 10 and 14 MHz (CI10 and CI14), and THI were graded independently by 2 radiologists for lesion conspicuity, needle conspicuity, lesion and needle conspicuity, and overall image quality. Frequency CI at 10 MHz, CI14, and THI were compared with conventional imaging. Different clinical scenarios (fatty versus glandular background, fine needle versus core needle, and oblique versus horizontal needle direction) were evaluated. RESULTS: Statistical analysis showed that for overall image quality, CI10 was the best setting (odds ratios [OR], 3.67 and 7.48). For lesion conspicuity, CI14 (OR, 3.55) and THI (OR, 1.77) improved lesion visibility in a fatty background, whereas THI (OR, 0.26) was very limited in a glandular background. For needle conspicuity, no setting was better than conventional, whereas THI was the least valuable setting (OR, 0.011 and 0.049). For lesion and needle conspicuity, CI10 showed significantly better results than conventional for a dense background (P = .0268 and .4028; OR, 2.435 and 1.383) with 1 reviewer, whereas THI was the least valuable setting (OR, 0.014 and 0.042). CONCLUSIONS: Conventional imaging provided the best assessment of lesion and needle conspicuity. Frequency compounding is a useful setting for dense breast and for fine-needle aspiration. Tissue harmonic imaging has a role in the visualization of a lesion against a fatty background but is of limited value in needle visualization.     

乳头溢液性疾病的超声征象与乳管内窥镜检查结果的对比分析

目的 评价超声对乳头溢液性疾病的临床诊断价值.方法 对57例乳头溢液性疾病患者分别行超声和乳管内窥镜检查,将超声征象与乳管镜结果进行对比分析.结果 超声对乳头溢液性疾病阳性征象诊断率为96.49%:导管扩张27例(47.36%),实性肿物伴导管扩张或囊肿19例(33.33%),囊性回声6例(10.52%),实性回声3例(5.26%),超声无异常征象2例(3.51%).乳管镜诊断:乳腺导管炎26例(45.61%),导管扩张症12例(21.05%),导管内乳头状瘤或乳头状瘤病17例(29.82%),乳腺癌2例(3.50%).超声对实性病变的诊断敏感性为52.63%,特异性为89.47%,误诊率为10.50%,漏诊率为47.36%.结论 超声对乳头溢液性疾病有较高的敏感性,但对此类疾病中实性病变的漏误诊率较高.