纤维乳管镜对乳头溢液患者的诊断价值——附104例报告

Diagnostic Value of Fiberoptic Ductoscopy in Patients with Nipple Discharge:A Report of 104 Cases

目的评价纤维光导乳管镜检查对乳头溢液的应用价值。方法应用德国Scholly Fiberoptic GmbH42.0500型半硬性纤维光导乳管镜检查系统对104例乳头溢液进行诊断,并与术后病理诊断作对比分析。结果104例均成功检查。对乳管内占位性病变的检出率94%(49/52)。乳管镜诊断乳腺导管癌的敏感性为50%(1/2),特异性为91%(43/47),阴性预测值为98%(43/44),阳性预测值为20%(1/5),准确性为90%(44/49)。乳头状瘤病镜下诊断5例,其中3例与病理诊断符合,符合率60%;另2例为多发性乳头状瘤,均行腺叶切除。镜下诊断乳头状瘤38例,均行含病变乳管的腺叶部分切除术。55例乳管炎性疾病未行手术,3例(3%,3/104)因继续溢液行乳管镜复诊检出先前漏检之乳头状瘤后经手术证实。结论乳管镜能明确乳头溢液病因,确定病变部位,是乳头溢液的首选检查方法;使乳管炎与乳管扩张症免于手术。

Objective To evaluate the applicative value of fiberoptic ductoscopy （FDS） in abnormal nipple discharge. Methods A total of 104 patients with nipple discharge were examined by fiberoptic ductoscopy （Germany Scholly Fiberoptic Gmbh 42. 0500）. The results were compared with postoperative pathological diagnosis. Results All the 104 cases were successfully diagnosed with FDS. The detectable rate for intraductal mass by ductoscopy is 94 % （49/52）. The sensitivity and specificity of ductoscopy for mammary duct cancer is 50% （1/2） and 91% （43/47） respectively; the negative predictive value is 98% （43/44） , positive predictive value is 20% （1/5） , and accuracy is 90% （44/49）. Five cases of papillomatosis were diagnosed by ductoscopy, in which 3 cases were consistent with postoperative pathological findings, therefore the diagnose accordance rate is 60% ; the other 2 cases were proven to be multiple papilloma. Thirty-eight cases of papilloma were detected by ductoscopy and received lobectomy of bresat ; 55 cases of inflammatory duct disease did not receive any operation; and 3 cases （3%, 3/104） were diagnosed papilloma by reexamination with ductoscopy due to persistent nipple discharge, and were confirmed after operation. Conclusions Fiberoptic ductoscopy is the first choice for examination of nipple discharge for its accuracy in finding pathogenic cause and locating lesion, and surgery can thereby be avoided for galactophoritis and mammarv duct ectasia patients.