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。     

乳管镜检查在乳头溢液中的地位

乳头溢液是乳腺疾病中常见的临床症状之一 ,约 10 %的妇女在常规体格检查时可以被发现有乳头溢液 ,其中 35 %～ 4 8%的患者病因为乳腺导管内乳头状瘤或乳头状瘤病 ,约 10 %的患者为恶性肿瘤[1、5] 。本病的确诊有赖于病理检查 ,自乳腺导管内窥镜成功应用于临床检查后 ,使我们能在电视屏幕上直接观察乳头溢液患者乳腺导管上皮及导管腔内的情况 ,并追踪其变化 ,做出诊断。使乳头溢液的病因诊断得到了很大发展。一、乳头溢液的病因女性的乳腺中都有 15～ 2 0条主乳管 ,分别开口于乳头 ,再呈树枝样分支进入乳腺组织。当这些主乳管、分支及其周围…     

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。     

乳管镜在乳头溢液诊治中的临床应用价值

目的:探讨乳管镜在病理性乳头溢液诊断中的临床应用价值。方法:回顾性分析1 606例经乳管镜检查并行手术切除的病理性乳头溢液患者患者的临床资料。结果:乳管镜检查结果与病理结果尚不完全符合,但两种方法一致性较高(Κ=0.828)。乳管镜诊断的灵敏度为95.5%,特异度为88.6%,与病理诊断的符合率为94.0%。结论:乳管镜在乳头溢液检测中具有良好的灵敏性和特异性,且与病理结果具有高度的一致性,可作为临床诊断乳腺疾病的重要手段。     

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.     

乳管镜诊治乳头溢液206例报告

目的探讨乳管镜诊治乳头溢液的效果。方法2001年5月-2006年10月,对206例乳头溢液行乳管镜检查221次。结果乳管镜诊断为乳管内非隆起样病变58例,行冲洗治疗,随访3—18个月,平均12个月,无复发。隆起样病变148例,其中125例手术治疗,乳管镜诊断单发乳管内乳头状瘤115例、乳头状瘤病7例、导管内癌3例,术后病理证实乳管内乳头状瘤112例,乳头状瘤病10例,导管原位癌3例。其中120例行乳腺定位针下病变乳管切除术,1例行区段乳腺腺体切除术,1例行“腺体置换”手术,1例行保留乳头的象限切除术联合腋窝淋巴结清扫,2例行不保留乳头的象限切除联合腋窝淋巴结清扫。随访4—20个月,平均10个月,无复发。3例导管原位癌随访12—18个月,无瘤生存。结论乳管镜检查对乳头溢液乳管内肿瘤术前诊断准确,而且对手术方式的选择具有重要临床意义。利用乳腺定位针直视下对乳管内病变定位,指导手术治疗。     

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.     

乳管镜诊断乳头溢液性疾病的后续治疗

目的探讨乳头溢液性疾病乳管镜诊断后的治疗措施。方法采用乳管镜对51例乳头溢液的病变导管进行观察、评估，并根据乳管镜下的不同表现特征实施治疗。乳头溢液性疾病的乳管镜下病变表现特征可分为隆起性病变和非隆起性病变，隆起性病变又分为结节状隆起和不规则隆起。本组结节状隆起29例，采取病灶局部切除23例，单纯乳腺切除6例；不规则隆起1例，病灶切除活检证实为乳腺癌后按恶性肿瘤的原则治疗；非隆起性病变21例，行乳管镜下冲洗治疗18例，3例有血性病变导管及其所属小叶切除术后石蜡切片病理诊断乳腺癌后按恶性肿瘤治疗。结果51例随访6～21个月，平均14个月，B超及胸片未见复发转移。结论乳管镜下的病变表现特征是乳头溢液性疾病制定治疗措施的重要依据。     

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…     

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。     

Nonsurgical Evaluation of Pathologic Nipple Discharge

Background:Nipple discharge is a common breast complaint. Because most nipple discharge is a result of benign processes, less-invasive, nonsurgical diagnostic modalities have been explored to reduce the need for surgical intervention.Methods:Between September 1994 and December 2000, 108 female patients aged 25 to 77 years underwent duct excision for bloody or clear nipple discharge. Results of various preoperative studies were compared with surgical pathology to determine the sensitivity, specificity, positive predictive value, and negative predictive value of these tests in detecting malignant ductal pathology.Results:Of the 108 surgical histopathology specimens, 90 of 108 patients were benign, 5 of 108 patients were atypical, and 13 of 108 patients were malignant. The sensitivity of mammography was 57.1%, specificity was 61.5%, positive predictive value was 16.7%, and negative predictive value was 91.4%. Hemoccult sensitivity was 50%, specificity was 0%, positive predictive value was 20%, and negative predictive value was 0%. The sensitivity of ductography was 0%, specificity was 90%, positive predictive value was 0%, and negative predictive value was 81.8%. The sensitivity of cytology was 11.1%, specificity was 96.3%, positive predictive value was 50%, and negative predictive value was 76.5%.Conclusions:Preoperative evaluations by mammography, Hemoccult, ductography, and cytology are poor predictors of histological diagnosis. These data suggest that patients with pathologic nipple discharge should undergo surgical biopsy for accurate diagnosis.Presented at the Society of Surgical Oncologys 55th Annual Cancer Symposium, Denver, Colorado, March 14–17, 2002     

Pathologic Nipple Discharge: Surgery Is Imperative in Postmenopausal Women

Background A total of 10% to 15% of pathologic nipple discharge in women is due to malignant lesions of the breast. The purpose of this study was to discover the rate of breast cancer in women who present with this symptom and undergo ductal excision, to evaluate the different diagnostic methods used before surgery, and to discover whether there are specific factors with regard to dignity.Methods We analyzed 118 ductal excisions in 116 patients performed at the women’s hospital of the University of Rostock, Germany, between 1995 and 2002. The discharging duct was identified by preoperative galactography.Results The rate of cancer in these patients was 9.3% (n = 11). The most frequent benign lesion was intraductal papillomatous proliferation (36.4%; n = 43). Solitary papillomas were shown in 21.2% (n = 25), and other specific benign histologic findings were shown in 27.1% (n = 32). Women with malignancies were significantly older (P = .009) and were more often postmenopausal (P = .095) compared with patients with benign histology. Galactography was the method that reached the highest sensitivity (73%), and clinical examination showed the highest specificity (85%) in distinguishing between benign and malignant lesions.Conclusions Because 94.1% of all cases presented with specific histological findings causing pathologic nipple discharge, ductal excision combined with preoperative galactography was proven to be a sufficient method for diagnosis and therapy. This procedure should be performed in all postmenopausal women with this symptom because of a cancer rate of 12.7% among this age group and the unsatisfactory quality of other diagnostic methods.     

Mammary Ductoscopy for Evaluation of Nipple Discharge

Background  Most breast cancers originate in the ductal epithelium with normal cells progressing to atypia and finally to carcinoma. Ductoscopy enables one to visualize and sample the ductal epithelium and therefore identify early changes cytologically. This report describes our experience with mammary ductoscopy as a tool for evaluation of nipple discharge at Beth Israel Medical Center. Methods  A prospective review of all patients who have undergone ductoscopy for evaluation of persistent nipple discharge was performed. The Acueity ductoscopy system with .9-mm scope and a video monitor with ×60 magnification were used. Brush biopsy samples and lavage fluid were obtained from some patients and were sent for cytologic analysis. A subset of patients underwent ductoscopically guided duct excision. Results  Ninety-three patients underwent ductoscopic evaluation of 110 ducts. Of these, 67 patients had abnormal findings and therefore underwent ductoscopically guided duct excision. The remaining 26 patients (28%) had normal ductoscopic examinations. The depth at which intraductal abnormalities were visualized was from 3 to 8 cm with an average of 4.4 cm for cancer cases and from 1 to 10 cm with an average of 4.5 cm for papillomas. Forty-two patients were diagnosed with papilloma/papillomatosis, six patients were diagnosed with atypical papilloma/atypical ductal hyperplasia/atypical lobular hyperplasia, and six patients were diagnosed with cancer. Of the six patients diagnosed with cancer, 67% had normal breast imaging, and other than nipple discharge, 67% had normal breast examinations. Conclusion  Mammary ductoscopy is a useful tool in the evaluation of patients with nipple discharge. Although the most common cause of nipple discharge is an intraductal papilloma, nipple discharge can be the presenting symptom for cancer. Our experience revealed a papilloma rate of 45% (42 of 93), cancer rate of 6.5% (6 of 93), and an atypia rate of 6.5% (6 of 93) among the patients with nipple discharge. Mammary ductoscopy allows for accurate visualization, analysis, and excision of intraductal abnormalities. Many deeper intraductal abnormalities could be missed by blind surgical excision. Poster presentation at the 29th Annual Symposium of American Society of Breast Diseases, April 14–16, 2005, Las Vegas, Nevada.     

996例纤维乳管镜诊治分析

目的探讨乳管镜诊治乳管内早期病变的价值。方法2009年1月-2011年12月,采用日本FiberTeehr-FT-201型乳管镜对996例非乳汁性乳头溢液及部分无乳头溢液进行诊断、灌洗治疗、定位、活检。其中镜下植入定位针532例,灌洗治疗197例,取活检114例。结果996例乳管镜诊断乳头状瘤和乳头状瘤病697例,似乳管癌99例,乳管积液扩张123例,平坦型红斑病变4例,毛细血管扩张2例,闭塞性乳管炎50例,余21例乳管镜除乳管扩张外未见明显异常。镜下植入定位针准确扎入瘤体460例,准确率86．5％（460／532）。镜下灌洗治愈乳管炎196例,治愈率99．5％（196／197）。镜下活检成功取出瘤体组织98例,成功率86．0％（98／114）。结论乳管镜可作为诊治乳管内早期病变的首选措施,其所起到的作用是B超、钼靶所不及的。     

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目的 通过用导管内窥镜观察乳头溢液病人乳腺导管内特征,为乳头溢液的病因诊断提供依据。方法 用乳腺导管内窥镜对２２例乳头溢液病人进行检查。结果 ２２例病人中发现良性病１９例,其中５例为导管内乳头状瘤,１４例为乳腺增生、乳腺导管扩张症或有服管炎。另３全炙恶性肿瘤,均经病理证实为原位癌或管内癌。结论 乳管内窥镜检查乳腺病是一种崭新的诊断方法,对早期乳腺癌诊断有重要的作用,将对乳腺癌的治疗产生深远影响。     

纤维乳腺导管内镜辅助诊治乳头溢液632例报告

目的探讨纤维乳腺导管内镜对Tis期乳腺癌的临床诊断价值。方法 2001年5月～2010年5月,对632例乳头溢液进行乳腺导管内镜检查702次,并对其中310例隆起性病变行乳腺导管内镜辅助定位手术。结果 475例诊断为隆起性病变,包括乳管内乳头状瘤388例（61.4%）,乳管内乳头状瘤病79例（12.5%）,导管内癌8例（1.3%）;157例为非隆起性病变,包括导管扩张症82例（13.0%）,慢性乳管炎73例（11.6%）和导管内癌2例（0.3%）。310例行乳腺导管内镜辅助定位手术,内镜诊断对导管内癌的阳性预测值为83.3%（10/12）。结论 纤维乳腺导管内镜检查弥补了伴有乳头溢液的Tis期乳腺癌诊断的空白,对乳腺癌的早期诊断有积极的意义。     

The Predictive Value of Ductography and Magnetic Resonance Imaging in the Management of Nipple Discharge

Background Standard evaluation (physical examination, mammography, sonography) often fails to identify an underlying lesion in patients with suspicious nipple discharge. The aim of this study was to determine the predictive value of ductography (DG) and magnetic resonance imaging (MRI) in this setting. Methods Using ICD-9 codes, we retrospectively identified 376 patients who presented with suspicious nipple discharge (ND) (1995–2005); 306 patients (68%) had negative standard evaluation. Results Among 306 patients, 186 (61%) underwent further evaluation with DG (n = 163) and/or MRI (n = 52), 35 (11%) underwent major duct excision alone (MDE), and 85 (28%) were followed clinically. Ultimately, 182/306 (59%) patients underwent surgery and/or biopsy. Overall incidence of malignant or high-risk pathology was 15% (46/306). DG was completed in 139/163 (85%) studies and detected 12 cancers and seven high-risk lesions (HRL), but failed to identify four cancers and 2 HRL (PPV 19%, NPV 63%). MRI detected seven cancers and three HRL, but failed to identify one cancer and one HRL (PPV 56%, NPV 87%). MDE alone (n = 35) detected five cancers and three HRL. Of all patients not having surgery, (142/306, 41%), one (0.01%) presented with an invasive cancer at 102 months (median follow-up, 6.3 months; range, 0–124 months). Conclusions An underlying malignancy was identified in 30/306 (10%) patients with ND and negative standard evaluation. Ductography is a poor predictor of underlying pathology and cannot exclude malignancy. MRI’s higher predictive values may allow for improved patient selection and treatment planning; however, MRI should not replace MDE as the gold standard to exclude malignancy in patients with ND and negative standard evaluation.     

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.