血性溢液性乳腺疾病的导管造影检查与病理对照分析

目的 :探讨乳腺导管造影在血性溢液性乳腺疾病中的诊断价值。方法 :回顾性分析经临床病理证实的39例乳头血性溢液患者的导管造影X线表现,并与病理结果进行对比分析。结果:本组39例中,造影诊断导管内乳头状瘤27例(69.2%);乳腺癌9例(23.1%);导管扩张囊性增生1例(0.3%);导管炎症导管内分泌物潴留2例(0.5%)。经病理证实,导管造影诊断符合率为89.7%,误诊4例,占10.3%。结论 :乳腺导管造影对血性溢液性乳腺疾病的定性、定位具有较高的诊断价值,尤其对临床触及阴性的导管内乳头状瘤及早期乳腺癌能作出较准确诊断,提高了导管内占位性病变的检出率。     

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。     

溢液性乳腺癌的乳腺导管造影表现及病理基础

目的:分析溢液性乳腺癌的乳腺导管造影表现及其病理基础,为临床提供可靠的诊断依据,以提高早期乳腺癌的诊治水平。方法:临床表现为乳头溢液并经手术、病理证实的乳腺癌患者26例,回顾性观察其乳腺导管造影表现,并与病理结果对比分析。结果:26例中,导管原位癌8例;浸润性导管癌5例;导管原位癌伴早期浸润7例;复合型癌3例,其中导管原位癌合并浸润性小叶癌2例,浸润性导管癌合并浸润性小叶癌1例;导管内乳头状瘤病癌变3例,其中乳腺X线平片未发现异常5例,毛刺或分叶状肿块2例,肿块伴钙化9例,多形性钙化灶10例。乳腺导管造影主要表现:导管内充盈缺损伴有不同程度导管扩张;导管管壁浸润破坏对比剂渗漏,形成"潭湖征";导管管壁不规则,呈"虫蚀样"改变或"断续征"。本组乳腺导管造影诊断乳腺癌的符合率为88.4%。结论:乳腺导管造影是溢液性乳腺癌诊断的安全而有效的检查方法,具有很高的定性、定位诊断价值,尤其对临床触诊阴性的早期乳腺癌能作出较准确的诊断,提高了早期乳腺癌的检出率。     

乳腺导管造影在乳腺导管溢液性疾病中的诊断价值

目的：探讨乳腺导管造影在乳腺导管溢液性疾病中的诊断价值。方法：回顾分析了52例乳腺导管溢液性疾病的造影检查资料，病例均经临床检查、钼靶摄片、乳腺导管造影检查及病理证实。结果：肿瘤性病变37例．包括导管内乳头状瘤（单发和多发）30例，导管内乳头状癌2例，浸润性导管5例，其中导管内乳头状瘤最为多见。非肿瘤性病变15例，其中单纯导管扩张症U例，导管扩张伴炎症4例；其中以单纯导管扩张症最为多见。结论：乳腺导管造影对乳腺导管溢液性疾病的诊断与鉴别诊断具有重要的价值。     

乳腺导管造影在溢液乳腺疾病诊断中的应用价值(附70例报告)

目的探讨乳腺导管造影在溢液乳腺疾病诊断中的应用价值。方法回顾性分析70例经手术及病理确诊的乳头溢液乳腺病的X线特点,结合临床及病理特征进行鉴别诊断。结果导管内乳头状瘤45例,导管癌5例,导管扩张症17例,导管增生伴炎症3例。结论乳腺导管造影在导管肿瘤良恶性的鉴别及导管炎性疾病的诊断中有极高的应用价值,可为临床提供准确的诊断和治疗依据。     

全数字化乳腺摄影对妇女致密型乳腺病变的诊断价值

目的探讨全数字化乳腺摄影（FFDM）对妇女致密型乳腺病变的诊断价值。方法搜集2003年4月至2004年9月门诊及体检者行FFDM的3500余例中致密型乳腺的66例乳腺癌及6例癌前病变，12例囊性增生症，58例纤维腺瘤，1例结核，4例囊肿，11例乳腺腺病作为研究对象。全部病例采用美国GE公司的平板2000D全数字化乳腺摄影机检查，并经病理证实。检查体位常规采用头足位（CC）、内外斜位（MLO），必要时加摄侧位及局部点片。对临床未触及肿块的乳腺癌，均行术前定位。结果72例乳腺癌及癌前病变中，临床触及肿块者57例，未触及肿块者15例。影像表现为肿块23例；肿块并微小钙化18例；片状弥漫微小钙化伴局部结构紊乱11例；结构紊乱并粗长毛刺12例；簇状微小钙化2例；片簇状微小钙化1例；结构紊乱1例；小星状结构1例；长毛刺星状结构1例；平片无明显影像表现2例，其中1例仅导管造影显示僵硬、中断。共发现假阳性10例，假阴性5例，得出FFDM对乳腺癌诊断的敏感性、特异性、准确性分别为93．06％、88．37％、90．51％。良性病变中，58例纤维腺瘤，表现为肿块38例，肿块伴钙化20例；12例囊性增生症，表现为肿块10例，肿块伴点状钙化2例；11例乳腺腺病，表现为肿块9例，肿块伴点状钙化2例。4例囊肿和1例结核，均表现为肿块。结论FFDM能清晰显示乳腺癌的直接及间接征象，尤其能够显示致密乳腺的结构紊乱、粗长毛刺及微小钙化，对临床未触及肿块的乳腺癌及癌前病变具有重要的诊断价值。     

乳腺X线导管造影和染色定位对乳腺疾病的临床价值探讨

目的:探讨乳腺X线导管造影和染色定位的操作摄影技术要求及其X线特征。方法:回顾分析经手术切除和穿刺活检病理证实的60例乳腺疾病的乳腺导管造影和染色定位资料。结果:本组3例穿刺失败,57例导管造影成功,53例导管造影的影像诊断与手术及穿刺活检证实的结果相同。肿瘤性病变10例,非肿瘤性病变47例。38例术前行染色定位,术中使得病灶形态显示更为全面和直观。结论:导管造影和染色定位可对乳腺疾病的诊断、临床术前术中评估及手术方案的制订提供更全面、更有价值的信息。     

乳腺导管造影对乳头溢液性疾病的诊断价值

目的 探讨乳腺导管造影在溢液性乳腺疾病诊断中的价值.方法 回顾性分析经手术和病理证实的101例溢液性乳腺病的导管造影表现.结果 乳腺导管扩张症23例;乳腺囊性增生症12例;乳腺导管炎8例;导管内乳头状瘤46例;乳腺导管癌9例;乳腺导管结核1例;导管未见异常2例.结论 乳腺导管造影有助于乳头溢液的病因诊断.其在导管良恶性病变的鉴别诊断中有极高的价值.     

MRI在乳腺疾病中的应用价值

目的:探讨MRI对乳腺疾病的临床应用价值.方法:回顾性分析135例经手术病理证实的乳腺疾病患者的病例资料.分析比较乳腺良恶性病变的MRI平扫和动态增强表现及时间-信号强度曲线(TIC)的特点,并与乳腺X线摄影结果进行对照.结果:135例患者共发现142个病灶,其中恶性病变64个,良性病变78个.乳腺良性病变的主要平扫MRI表现:T1WI呈低信号42个、等信号32个、高信号4个;T2WI呈低信号2个、等信号20个、高信号56个.恶性病变的主要平扫MRI表现:T1WI呈低信号48个、等信号14个、高信号2个;T2WI呈低信号1个、等信号13个、高信号50个.增强扫描:良性病变多为较均匀强化,以Ⅰ型(持续强化)曲线为主(56个);恶性病变强化多不均匀、以Ⅲ型曲线(廓清型)为主(47个).动态增强扫描对乳腺良恶性病变的诊断符合率为90.8%,优于平扫MRI (71.8%)和乳腺X线摄影(65.5%).结论:MRI平扫加增强扫描是评价乳腺疾病的一种有效影像学方法,尤其是动态增强MRI更有助于良恶性病变的鉴别.     

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.     

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。     

乳管镜下乳头溢液的性状与乳管内病变的相关性

 目的 探讨乳头溢液颜色及溢液量与乳管内相应病变之间的关系。方法 对2014-05至2014-12于武警总医院门诊行乳管镜检查并行相应治疗的174例乳头溢液患者的临床资料进行回顾性分析。结果 174例乳头溢液患者有乳管内占位性病变者共83例(47.7%),其中乳腺癌5例;乳管内无占位性病变者91例(52.3%)。单侧溢液、单孔溢液分别较双侧溢液、多孔溢液在乳管镜下发现乳管内占位的可能性大(P<0.05),血性溢液、淡黄色溢液较其他颜色溢液在乳管镜下发现乳管内占位的可能性大(P<0.05),血性溢液较非血性溢液提示乳腺癌可能性大(P<0.05),单侧溢液中单孔溢液和多孔溢液两者乳管内占位发生率比较无统计学差异。结论 乳头溢液是乳管内病变的早期表现,其中单侧溢液、单孔溢液、血性溢液、淡黄色溢液均提示乳管内占位性病变可能性大,单纯血性溢液是乳腺癌高危因素,单侧溢液无论单孔还是多孔都有临床意义。     

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。     

The diagnostic value of galactography in patients with nipple discharge

To evaluate preoperative galactographic findings in the differentiation between the benign and malignant lesions in patients presenting spontaneous nipple discharge without mass. Of the 215 patients who have undergone the galactography, 181 cases with abnormal galactography had surgery performed. All galactrograms were reviewed and galactographic findings were correlated to the pathological results to determine diagnostic differentiation. Of the 181 cases we operated on, 112 cases were macroscopically bloody, with 30 cases having cancers (26.8%). Fifty-four cases with serous discharge had seven cancer cases (13.0%). No cancer cases with other color discharge were found. Of the 37 cancer cases, 11 cases had lesions located in the main mammary ducts (lactiferous duct and the segmental duct) (29.7%) and 26 cases had lesions in the peripheral ducts (the subsegmental duct and its branches) (70.3%) (P<.05). Of 113 cases with benign proliferative ductal lesions, 88 cases were located in the main mammary duct (77.9%) and 25 cases in the peripheral mammary duct (22.1%) (P<.05). Otherwise, 29 cancer cases (82.9%) had ductal obstructions and 28 cancer cases (75.7%) had irregular intraductal defects that appeared in the galactograms, which is different from the 113 benign proliferative ductal lesion cases that had 88 cases (71.7%) with ductal dilatation and 90 cases (79.6%) with lobular or smooth intraductal defects (P<.05). These results showed that the cancer cases had a higher rate of locating in the peripheral duct, irregular intraductal duct defects, and ductal obstruction, and a lower rate associated with ductal dilatation or torsion. The galactographic findings were evaluated using the tumor location, types of intraductal defects, ductal obstruction, and dilatation. Preoperative diagnostic galactography is useful in differentiating between the benign or malignant lesions in patients with spontaneous nipple discharge.     

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.     

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.     

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.