乳头溢液的影像学诊断

目的：评价乳腺导管造影和钼靶X线平片摄影在乳头溢液患者诊断中的临床价值。方法：回顾性分析50例乳头溢液患者的钼靶X线检查资料，所有病例均经临床检查，钼靶X线平片摄影、乳腺导管造影检查及病理学检查确诊。结果：良性病变47例，其中乳腺导管内乳头状瘤35例，乳腺囊性增生病7例，导管扩张5例；乳腺导管癌3例；乳头溢液伴肿块者19例。乳腺钼靶X线平片摄影发现14例乳头溢液伴肿块者X线表现异常，乳腺导管造影发现导管内乳头状瘤28例（28／35），乳腺增生病2例（2／7），导管扩张症4例（4／5），乳腺导管癌1例（1／3）。结论：乳腺导管造影用于诊断乳腺导管系统疾病较为准确可靠，乳腺钼靶X线平片摄影对乳头溢液的诊断价值不大，一定条件下两者可联合应用。     

溢液乳腺疾病乳腺导管造影表现与病理(附105例分析)

目的分析溢液乳腺疾病的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法对临床表现为乳头溢液并经手术、病理证实的溢液乳腺疾病105例,包括乳腺癌12例、导管内乳头状瘤38例、乳腺导管扩张症43例及12例乳腺囊性增生病,回顾性分析其乳腺导管造影的影像表现及病理特征。结果本组乳腺导管造影正确诊断乳腺癌11例,导管内乳头状瘤35例,乳腺导管扩张症41例,乳腺囊性增生病12例。乳腺癌主要造影表现：导管内充盈缺损,管壁浸润;＂潭湖征＂;导管结构紊乱;管壁不规则伴微钙化灶;乳头状瘤病伴导管壁毛糙破坏,提示恶变。单发导管内乳头状瘤造影表现为大导管内边缘光滑的充盈缺损,导管边缘光整;多发者表现为小分支导管内多发边缘光滑之充盈缺损。乳腺导管扩张症造影表现：大、中、小导管同时不同程度地扩张,或伴有管壁毛糙,分支导管萎缩变形等炎症表现。乳腺囊性增生病中囊肿表现为小导管高度扩张形成囊袋状改变,盲管腺病表现为小导管或末梢导管呈多发小囊袋状改变。结论乳腺导管造影对溢液性乳腺疾病是一项安全而有效的检查方法,对乳腺导管内占位性病变的定性、定位诊断具有高度价值,对导管扩张症、乳腺囊性增生病等疾病亦能作出较准确的诊断。     

Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis

Purpose  To evaluate the galactographic findings taken with digital mammography and to compare the findings between benign and malignant breast diseases. Materials and methods  Galactographic findings were retrospectively analyzed and compared with histopathological results for 42 patients who showed abnormal findings on galactography and had histologically proven diagnoses between January 2005 and March 2008. A galactography was acquired using full-field digital mammography (Hologic Lorad Selenia; Danbury, USA). The difference in galactographic findings between malignant and benign breast diseases was analyzed using χ² test. A value of P < 0.05 was considered statistically significant. Results  Of the total 42 cases, 11 cases were malignant breast diseases and 31 were benign diseases. Common galactographic findings of benign diseases include ductal obstruction (48.3%) and single filling defect (51.6%), and common findings for malignant tumor include ductal dilatation (72.7%) and stenosis (63.6%). Ductal stenosis, microcalcifications or mass adjacent to abnormal duct, multiple filling defects, ductal wall irregularity, ductal distortion and irregular filling defects were more prevalently seen in malignant cases. A single filling defect and lobular filling defect was more prevalently seen in benign cases (P < 0.05). Ductal dilatation was a common finding in both malignant and benign cases with no significant difference. Conclusions  Ductal lesions were well visualized on galactography acquired with a digital mammography. A preoperative diagnostic galactography is useful in making a differential diagnosis between benign diseases and malignant tumors in patients with pathologic nipple discharge.     

溢液性乳腺病的造影诊断

目的：探讨乳腺导管造影在溢液性乳腺病中的应用。方法：回顾分析了64例72支乳导管的造影检查资料,病例均经临床检查、钼靶摄片、乳导管造影检查及病理证实。结果：导管正常者10例,占13．9％;单纯导管扩张症28例,占38．9％;导管扩张伴慢性乳腺炎7例,占9．7％;导管内乳头状瘤19例,占26．4％;导管内乳头状癌6例,占8．3％;多发性导管内乳头状瘤2例,占2．8％,其中以导管扩张最为多见。结论：乳腺导管造影术对溢液性乳腺病的诊断与鉴别诊断有很大的价值。     

乳腺癌的X线表现(附72例分析)

目的:探讨乳腺癌的X线表现。材料与方法:72例乳腺癌患者均为已婚妇女,年龄28～81岁,术前均经钼靶X线摄片,其中9例同时行乳腺导管造影。全部患者的X线诊断结果均经术后病理证实。结果:依据72例乳腺癌的X线表现,其病变大致可分为4种类型:(1)肿块型见于54例,(2)钙化型见于13例(其中11例合并肿块型,仅2例为单纯钙化型),(3)结构紊乱型见于7例,以及(4)导管扩张型见于6例。结果表明,乳腺癌的放射学表现是复杂多变的。结论:乳腺钼靶和乳腺导管造影摄片目前仍不失为诊断乳腺癌的一种有效而实用的方法。     

A comparison of mr imaging,galactography and ultrasonography in patients with nipple discharge

BACKGROUND: The aim of this study is to assess the usefulness of three-dimensional contrast-enhanced magnetic resonance (MR) imaging, compared with galactography and ultrasonography(US). METHODS: Fifty-five patients with bloody nipple discharge were investigated retrospectively. All patients were examined by galactography, ultrasonography and MR imaging. These three sets of findings were compared with the histopathological results from 16 intraductal biopsies, 3 excisional biopsies, 24 microdochectomies and 12 mastectomies. RESULTS: Contrast enhanced MR imaging demonstrated all malignant lesions including ductal carcinoma in situ (DCIS). Four cases of DCIS were not visualized by ultrasonography and three malignant lesions were missed by galactography. In the MR study, segmental clumped enhancement (positive predictive value =100 %), and focal mass with smooth border (negative predictive value =87.5 %) were the statistically significant predictive factors. CONCLUSIONS: Among the three modalities, contrast-enhanced three-dimensional MR imaging demonstrated the location and distribution of the lesions most clearly, especially in cases of ductal carcinoma in situ. It has the potential to be a useful diagnostic tool for patients with nipple discharge.     

乳腺导管造影对乳管内乳头状瘤的诊断价值

目的:探讨乳头状瘤钼靶X线片、导管造影的X线表现及其与临床病理关系。方法:回顾性分析80例乳管内乳头状瘤的临床特点,乳房钼靶X线片,导管造影表现及病理改变;并根据病变大小、形态,病变处导管形态及二者的关系,在导管造影片上进行X线分型且与病理改变进行对比。结果:80例均有单个乳孔溢液,血性分泌物52例,乳晕区触及肿块12例。乳房钼靶X线片示乳晕下区肿块10例。导管造影:80例均示导管内充盈缺损,其中18例并导管扩张。管内型56例,囊内型18例,实体型6例。钼靶X线表现与病理改变一致。结论:乳管内乳头状瘤最常见的临床表现是单个乳孔溢液,乳腺钼靶X线平片征象少;导管造影特点是管内充盈缺损,对乳头状瘤具有病变部位确断价值。     

选择性乳导管造影在乳管疾病诊断中的应用价值(附70例报告)

目的探讨选择性乳导管造影在乳管疾病鉴别诊断中的应用价值。方法对70例选择性乳导管造影并经手术病理证实的导管疾病影像表现行回顾性分析。结果导管内乳头状瘤(45/70)发病主要在一、二级导管内,肿块较小(1.0cm以下),呈单发或多发圆形、结节状充盈缺损,无断续征、潭湖征及导管壁的破坏;导管癌(5/70)主要发生在二级分支以下,侵及多支导管,导管内见数个不规则充盈缺损,导管近瘤体处突然中断形成断续征、截断征改变,导管内造影剂外溢形成潭湖征,被侵及导管呈锯齿样改变,周围合并肿块或恶性钙化影;导管扩张症(20/70)表现为大、中、小导管同时呈粗细不均的扩张,其逐级分支失去正常规则的树支样外形,以大导管扩张为主,扩张导管内无充盈缺损。结论乳腺导管造影对导管肿瘤良恶性的鉴别及导管炎性疾病的诊断有极高的应用价值,可为临床提供准确的诊断和治疗依据。