乳头血性溢液的外科治疗

目的总结乳头血性溢液的诊断与治疗方法。方法回顾性分析1997～2002年住院治疗的以乳头血性溢液为首发症状的74例病人的临床资料。结果在乳头血性溢液病人中乳管内乳头状瘤或乳头状瘤病63．5％，乳腺癌24．3％，乳腺导管扩张症8．1％，乳腺囊性增生症4．1％，其中乳腺癌年龄大于45岁者占乳腺癌病人的88．9％，乳腺癌伴有肿块者占乳腺癌病人的77．8％。结论对于乳头血性溢液应积极给予外科治疗，年龄45岁以上或伴有乳腺肿块的乳头血性溢液病人乳腺癌的可能性明显增加，对于早期发现和早期治疗乳腺癌有重要意义。     

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。     

乳腺导管内乳头状瘤65例临床分析

目的 探讨乳腺导管内乳头状瘤的发病情况及诊治措施.方法 对2000年11月至2011年9月经手术后病理证实的乳腺导管内乳头状瘤及乳头状瘤病的病例进行回顾性分析.结果 本组65例患者,其中49例患者首发症状为乳头溢液,占75.4%,16例以乳头乳晕区肿块来诊,占24.6%.术后石蜡病理诊断为乳管内乳头状瘤者56例,乳管内乳头状瘤病者5例,乳头状瘤病伴癌者4例,乳腺导管内乳头状瘤的恶变率是7.1%.49例乳头溢液患者行乳管镜检查,检出率为85.7%.结论 乳导管内乳头状瘤最常见症状为乳头溢液.术前行乳管镜检查有较高的确诊率.乳腺导管内乳头状瘤病有一定的恶变率.     

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。     

乳管内乳头状病变的临床分析：附1?211例报告

目的：探讨乳管内乳头状病变的临床病理特征及诊断方法。 方法：采用回顾性方法,对1?211例不同类型乳管内乳头状病变的年龄分布、乳头溢液与乳房肿块情况、病理及影像学检查结果进行分析。 结果：1?211例患者中,乳头状瘤874例,乳头状瘤病231例,乳头状癌106例;恶性病变患者平均年龄大于良性病变患者（P<0.01）,31~50岁为乳头状瘤及乳头状瘤病的高发年龄;16.0%患者有乳腺疾病手术史,乳头状瘤病患者中先后多次手术及同时双侧手术者明显多于乳头状瘤与乳头状癌患者（P<0.05）;67.8%患者有不同性质的乳头溢液,乳头状癌患者中溢液病例少于良性病变患者,但血性溢液明显多于良性病变患者（P<0.05）;约80%的良性病变术中可见肿块,恶性者术中均可见肿块,乳头状瘤病患者中伴有中-重不典型增生者明显多于乳头状瘤（P<0.05）,肿块>1.0 cm时常伴有中-重不典型增生,乳头状癌患者肿块平均最大径（1.93±0.78）cm;导管造影及导管镜检查对良性病变诊断的准确率高于彩色B超和钼靶（P<0.05）。 结论：不同类型乳管内乳头状病变有一些共同表现,也有各自特征,掌握这些特征有利于临床正确诊断及合理的治疗。     

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。     

乳管内视镜对乳腺导管内新生物的诊断价值

目的：评估乳腺导管内视镜对乳腺导管内新生物的诊断价值。方法：对乳头溢液病人行乳管内视镜检查,选择乳管镜发现新生物并行手术治疗的病例,分析乳腺肿块或结节扪诊、乳头溢液细胞学诊断及乳管镜诊断与病理组织学诊断间相互关系。结果：乳管镜诊断新生物的７９例中,肿块／结节形态、细胞学诊断及乳管镜诊断均与病理组织学诊断相关（Ｐ＜０．０１）。病理诊断管内乳头状瘤伴肿块者占１２．９％（９／７０）,诊断导管内癌伴肿块者占导管内癌组的５５．６％（５／９）;细胞学对管内乳头状瘤及导管内癌的诊断与病理切片诊断符合率分别为２０％（１４／７０）及７５％（６／８）,而乳管镜则分别为６０．６％（４３／７０）及８８．９％（８／９）。结论：轧管镜是术前诊断以乳头溢液为表现的乳腺管内乳头状瘤和导管内癌的有效手段。     

病理性乳头溢液病因的再认识

目的 认识病理性乳头溢液的病因.方法 从1990年来,对连续81例浆液性或血性乳头溢液患者行乳管切开检查.结果 发现乳管内乳头状瘤67例,乳管内乳头状瘤病5例,导管癌6例,3例未找到病变.结论 可能只有乳头状瘤(病)和导管癌是病理性乳头溢液的病因.     

乳管镜对双乳多孔溢液乳管内占位的诊断与价值

目的 探讨纤维乳管内视镜(乳管镜)对双乳多孔溢液乳管内占位的诊断的价值.方法 回顾性分析2004年6月-2009年5月诊治的双乳多孔溢液乳管内占位性病变135例患者的临床资料.结果 乳管镜诊断双乳乳管内乳头状瘤与病理符合率为75.0%,单乳乳管内乳头状瘤与病理符合率为78.2%,病理总符合率为82.2%,对于双乳乳管内乳头状瘤,黄色溢液较其他性质溢液明显为多(X<'2>=23.5675,P<0.05).结论 乳管镜对乳管内占位诊断符合率高,在乳头溢液的诊断上可作为首选检查方法,双乳多孔溢液中黄色溢液的双乳乳管内乳头状瘤所占比例较大,应予重视.     

乳管内乳头状瘤病的临床诊断经验

目的：总结乳管内乳头状瘤病的诊断经验。方法对713例乳头溢液患者的乳管镜检查结果中检出乳管内乳头状瘤病的病例进行分析及分型。结果乳管内乳头状瘤病共计42例（占总检出病例的16．34％）。其中包括单侧乳房单套乳管内多发肿瘤24例（占57．14％）,单侧乳房多套乳管内多发肿瘤13例（占30．95％）,双侧乳房多发肿瘤病例5例（占11．91％）。结论利用乳管镜对不同类型的乳管内乳头状瘤病进行准确分型,可以为临床上对此类疾病的诊疗提供合理的治疗策略和支持依据。     

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.     

Prospective study of outcome in women presenting with nipple discharge.

In this study, 56 women who presented to the breast clinic with nipple discharge have been reviewed. Patients were selected for surgery by a triple assessment of clinical examination, discharge cytology and breast imaging. Surgical intervention was required in 17 women. Significant pathology was found in 11 cases including five with carcinoma (in situ or invasive). Those women who did not have carcinoma detected at their initial presentation have been reviewed after a minimum of 5 years. None has gone on to develop breast cancer. We conclude that women with nipple discharge, but no positive findings on triple assessment, are not at an increased risk of the development of carcinoma. In addition, nipple discharge spontaneously resolves in 73% of women over a 5 year period.     

The Value of Breast Ductoscopy in Radiologically Negative Spontaneous/Persistent Nipple Discharge

Abstract:  Breast ductoscope is a fiberoptic endoscope used for examining the distal breast ducts under direct vision in order to identify the source of pathologic nipple discharge. The purpose of this study was to investigate the reliability of intra-operative breast ductoscopy in patients with pathologic nipple discharge, which could not be identified by radiologic tests. Between April 2002 and March 2007, breast ductoscopy was performed in 34 patients who had pathologic nipple discharge with no radiologic evidence about the source. The procedures were carried out under general anesthesia and ductoscopic findings were as well as the histopathology of the specimens were recorded and documented. In 88%, (30 of 34) of the patients, endoscope was successfully introduced into the external orifice of the ducts at the nipple and proximal breast ducts were successfully visualized. Ductoscopy revealed intraductal lesions (i.e., ductal obstruction, intraductal papilloma, red patches, and erythematoid platter) in 20 patients (66%). Among the 20 patients with visible endoluminal pathology, nine had a papilloma and eight had signs of either acute inflammation (bleeding, erythema) or previous inflammation with healing (adhesions and blocked ducts). In two cases, invasive breast carcinoma was identified, one of which was ductal carcinoma in situ (DCIS) with minimal invasion. In both cases, there had been blocked ducts. In one case DCIS was identified. Breast ductoscopy is a reliable and easy-to-use method to demonstrate the source of pathologic nipple discharge in cases with bleeding and other intraductal lesions.     

Usefulness of galactography for minimal noninvasive ductal carcinoma of the breast

Two cases of noninvasive ductal carcinoma detected by galactography are reported with reference to our diagnostic methods of a patient with nipple discharge. Abnormal nipple discharge with no demonstrable breast lump is rare but an important clinical sign, since it is sometimes produced by malignant lesions. Non-contrast mammography and cytologic examination is of limited diagnostic value for abnormal nipple discharge. Galactography is necessary for the detection of ductal carcinoma in early stage. The most important factor in improving the survival statistics for breast carcinoma is early detection.     

Does Nipple Discharge Color Predict (pre‐) Malignant Breast Pathology?

Unilateral single‐duct nipple discharge is associated with an increased risk for underlying breast malignancy. There is no consensus whether color of nipple discharge independently indicates the risk of malignancy. We sought to assess the relationship between the color of discharge and the risk of malignancy. Patients with unilateral single‐duct nipple discharge without abnormalities on clinical and radiologic examination were included. Prior to diagnostic microdochectomy nipple discharge characteristics were registered. Multiple logistic regressions were performed to assess the relationship between color of nipple discharge and malignancy, corrected for age. During a mean follow‐up period of 7.1 years we determined complication rate and false‐negative rate of microdochectomy. A total of 184 patients were included (median age 53 years, range 19–84). Histologic examination revealed (in situ or invasive) breast carcinoma in 10.9% (20) of patients and high‐risk lesions in 11.4% (21). Malignancy or high‐risk lesions were found in 25% (OR: 1.37; 95% CI: 0.62–3.00) of patients with bloody discharge. Risk of underlying malignancy increased in patients >60 years (OR: 2.35; 95% CI: 1.14–4.83). Complication rate of microdochectomy was 2.7%. Single‐duct, unilateral nipple discharge is a sign of underlying malignancy in a substantial proportion of cases. The majority of patients with unilateral single‐duct nipple discharge, diagnosed with breast cancer, present with bloody discharge. However, the association between bloody nipple discharge and malignancy is not strong enough to distinguish high‐risk patients. Therefore, invasive diagnostic procedures like microdochectomy should be offered to all patients with unilateral uniductal nipple discharge to search for underlying malignancy.     

Nipple discharge and the efficacy of duct cytology in evaluating breast cancer risk

BackgroundNipple discharge accounts for up to 5% of referrals to breast surgical services. With the vast majority of breast carcinomas originating in the ductal system, symptomatic dysfunction of this system often raises disproportionate clinical concern. The aim of this study is firstly, to evaluate the clinical importance of nipple discharge as an indicator of underlying malignancy and secondly, to assess the diagnostic application of duct cytology in patients presenting with nipple discharge.Study designWe performed a retrospective analysis of all patients presenting with nipple discharge as their primary symptom to the symptomatic breast unit at a tertiary referral center over a 30-month period (n = 313). The Hospital Inpatient Enquiry (HIPE) System and BreastHealth database were used to identify our study cohort. Parameters evaluated included patient demographics, clinical presentation, clinical evaluation, radiological assessment and histological/cytological analysis.ResultsThree-hundred and thirteen patients presented with nipple discharge as their primary complaint. Invasive breast carcinoma was diagnosed by Triple Assessment in 5% of patients. 24% of patients presenting with nipple discharge underwent nipple aspiration and cytological analysis. Duct cytology was diagnostic of the underlying breast carcinoma in 50% of triple assessment diagnosed carcinoma. Four risk factors were identified as having a significant association with breast carcinoma, these included (a) age >50 years (p < 0.0001), (b) bloody nipple discharge (p < 0.008), (c) presence of a breast lump (p < 0.0001) and (d) single duct discharge (p < 0.006).ConclusionsNipple discharge is a poor indicator of an underlying malignancy. Use of nipple aspiration and duct cytology for the assessment of nipple discharge is of limited diagnostic benefit. However, by utilizing the systematic, gold standard approach of Triple Assessment (clinical, radiological and cytological evaluation), the risk of underlying carcinoma can be accurately defined.     

Ten-year follow-up of breast carcinoma in situ in Connecticut.

Statistics from the Connecticut Tumor Registry from 1979 to 1988 were examined, and individual medical records from 1979 to 1983 were also reviewed. Three hundred nineteen medical records were available for review, documenting 220 cases of ductal carcinoma in situ and 102 cases of lobular carcinoma in situ. In 1979, there were 33 new cases of ductal carcinoma in situ reported to the Connecticut Tumor Registry, representing 1.8% of all breast cancers. There has been a yearly increase in ductal carcinoma in situ, with 200 new cases, or 7.4% of all breast cancers, reported in 1988. Forty-eight (22%) of 217 patients with ductal carcinoma in situ had bilateral breast involvement with ductal carcinoma in situ or an invasive breast cancer. Ten (83%) of 12 mastectomy specimens from patients with ductal carcinoma in situ who presented with nipple discharge demonstrated residual tumor, suggesting a more diffuse involvement. Two of the three reported recurrences involved nipple discharge. Thirty-seven (16.8%) of the 220 patients with ductal carcinoma in situ and six (5.9%) of the 102 patients with lobular carcinoma in situ were diagnosed as having another unrelated cancer. Ongoing clinical trials will direct optimum therapy for patients increasingly diagnosed as having ductal carcinoma in situ.     

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。     

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。