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。

The breast cancer with pathologic nipple discharge of galactographic features and the correlation between the galactographic and pathologic findings

Objective： To analyze the galaetographic feature in breast cancer with pathologic nipple discharge and the correlate with pathologic findings which is helpful for clinic in diagnosis,in order to improve the diagnostic and remedial level of patho- logic nipple discharge breast cancer, Methods： 26 cases of galactography features of breast cancer with pathologic nipple dis- charge proved by clinic and pathology were analyzed retrospectively and to correlate with the pathologic findings. Results： A- mong the 26 cases of breast cancer with pathologic nipple discharge,the pathology diagnosis included ：8 cases of ductal earcino ma in situ（DCIS）, 5 cases of infiltrating ductal carcinoma（IDC）,7 cases of DCIS associated with small invasive loci early infil- tration of ductal carcinoma, 2eases of duetal carcinoma in situ with infiltrating lobular carcinoma（DCfS-ILC）, 1 case of IDC with infiltrating obular earcinoma（ILC）, and 3 cases of malignant change of intraductal papillomatosis. Mammogram showed nor- mal findings in 5 cases, mass with irregular foliar and dim border in 2 cases, mass with micro-calcifications in 9 cases, and dif- fuse fill multiform clustered micro-calcifications in 10 cases. The galaetographic features of breast cancer with nipple discharge were as the following： lactiferous duct had circular intraductl filling defect with various degree ductal dilatation,mostly irregular intraductal defect with ductal wall breakage and ductal obstruction and torsion in the peripheral lactiferous duct and had ＂pool- like＂ signs due to encroaching and narrowing of lactiferous duct and had ＂Worm-bite-like＂ and ＂stop-continue＂ signs due to ir- regular invasion in the ducts and had ductal distortion by tumor n~lass compression,and tumor crush duct result in ductal ob struction. The accuracy rate of galactography in the diagnosis of breast cancer was 87 ~. Conclusions： Selective galactography is a safe, useful and effective method that accurate in the diagnostic workup of pathologic nipple discharging breast cancer. Galac- tography also has great value in diagnosis and localization of breast cancer with nipple discharge. Non palpable mass of early breast cancer with nipple discharge could be detected especially. In addition,galactography also could improve the detection rate of early breast cancer