纤维乳管镜及液基细胞学检查对病理性乳头溢液的诊断价值

目的:探讨纤维乳管镜(FDS)及液基细胞学检查(TCT)对病理性乳头溢液良恶性病变的诊断价值.方法:回顾分析434例行FDS及TCT检查的病理性乳头溢液病例资料,并将检查资料与术后病理活检结果进行比较分析.结果:全组434倒病例的FDS检查结果分析,其中溢液性质、末梢乳管出血情况、乳管情况的差异对良恶性病变的诊断差异均有统计学意义,P＜0.05.401例乳管内肿瘤占位病例的Logistic回归分析提示,肿瘤的位置(Ⅲ级或以上乳管)和肿瘤形状是评价乳管内肿瘤良恶性性质的主要指标.综合上述FDS图像特征的指标分析,FDS诊断乳头溢液恶性病变的敏感性为74.1％,特异性为75.0％；TCT诊断的敏感性为58.6％,特异性为98.9％；两者联合诊断的敏感性为86.2％,特异性为73.9％；FDS联合TCT检查的ROC曲线下的AUC面积为0.801,优于单独TCT或FDS检查.结论:FDS联合TCT检查有利于进一步提高乳头溢液中恶性病变的检出率,值得在临床推广应用.

Evaluation of fiberoptic ductoscopy system and thinprep cytology test in diagnosis of pathological nipple discharge

OBJECTIVE: To evaluate the diagnostic value of fiberoptic ductoscopy system(FDS) and thinprep cytology test(TCT) in pathological nipple discharge.METHODS: Clinical records of 434 patients with pathological nipple discharge undergoing FDS and TCT were retrospectively analyzed.The results of FDS and TCT were compared with pathological findings of subsequent surgical biopsy.RESULTS: According to the results of FDS in 434 patients,the character of discharge,hemorrhage of terminal duct and morphology of the duct were statistically significant predictors for diagnosis of malignant lesions(P<0.05).Among 401 patients with intraductal neoplasm,the logistic regression analysis showed that the location and shape of neoplasm were the main factors that predicted the malignancy of intraductal neoplasm.Based on the characteristic index of FDS image mentioned above,the sensitivity and specificity of FDS were 74.1% and 75.0% for the diagnosis of malignant lesions.The sensitivity and specificity of TCT were 58.6% and 98.9% respectively.The sensitivity and specificity of FDS combined with TCT were 86.2% and 73.9%.The area under curve(AUC) of the receiver operator characteristic(ROC) curve was 0.801,and was better than that of FDS or TCT alone.CONCLUSION: FDS combined with TCT are helpful to detect malignant lesions in nipple discharge and worth to be applied in clinical practice.