乳管内乳头状病变的临床分析:附1211例报告

Clinical analysis of intraductal papillary lesions of the breast:a report of 1 211 cases

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。

Objective： To investigate the clinicopathologic features and diagnostic methods of intraductal papillary lesions of the breast. Methods： Using a retrospective approach, the clinical data of 1 211 patients with different types of intraductal papillary lesions of the breast were analyzed, which included age distribution, characteristics of nipple discharge and breast mass, and results ofhistopathological and imaging examination.Results： Among the 1 211 patients, 874 cases were intraductal papilloma, 231 cases were papillomatosis, and 106 cases were papillocarcinoma. The average age of patients with malignant lesion was significantly higher than that of patients with benign lesion （P〈0.01）, and the high incidence age for papilloma and papiUomatosis was between the ages of 31 and 50 years. Sixteen percent of the patients had a history of breast disease surger）5 and the number of cases that experienced repeated breast surgery or bilateral breast surgery in papillomatosis patients was higher than that in papilloma or papillocarcinoma patients （P〈0.05）. Different types of nipple discharge occurred in 67.8% of the patients, and in papillocarcinoma patients, the number of cases with nipple discharge was lower but the number of cases with bloody discharge was higher than that in patients with benign lesion （P〈0.05）. Breast mass was seen, during surger）5 in about 80% of the patients with benign lesion and in all the patients with malignant lesion, and the incidence of moderate/severe atypical hyperplasia in papillomatosis patients was higher than that in papilloma patients （P〈0.05）; the mass greater than 1.0 cm was usually accompanied with moderate/severe atypical hyperplasia, and the average size of papillocarcinoma was （1.93±0.78） cm. The accuracy rate of galactography or fiber breast duct endoscopy for diagnosis of benign lesion was higher than that of ultrasound and mammography （P〈O.OS）. Conclusion： Different types of intraductal papillary lesions have some common manifastations, but also have their own characteristics, and knowledge about these features may be helpful for correct clinical diagnosis and treatment.