乳管内新生物活检联合乳头灌洗液CA153检测早期乳管内病变的研究

Diagnosis on early ductal pathological changes by fiberoptic ductoscopy-guided intraductal biopsy in combination with the detection of biomarker CA153

目的探讨乳管镜直视下乳腺导管内活检联合乳头灌洗液CA153检测对早期乳管内病变的诊断价值。方法收集2012年5月至2014年10月同济大学附属杨浦医院收治的行乳管镜检查的乳头溢液患者123例,对发现乳管内新生物的患者行导管内活检,并与导管切除术后病理诊断进行对照。同时收集行乳管镜活检患者的乳头灌洗液进行CA153检测,并与30例乳管扩张症患者的乳头灌洗液标本进行对照。结果 123例患者中共56例发现乳管内新生物,并行64次乳管镜下乳腺导管内活检及病变导管切除术。乳腺导管内活检显示,56例患者中导管内乳头状瘤28例、多发导管内乳头状瘤7例、导管上皮增生6例、导管上皮重度不典型增生2例和乳腺癌7例。另有6例活检失败,活检成功率为89.3%。病变导管切除术后病理诊断:单发导管内乳头状瘤29例、多发导管内乳头状瘤11例、导管上皮增生8例、导管上皮不典型增生1例、导管内癌4例、浸润性导管癌2例和导管内乳头状癌1例。30例乳管扩张症患者乳头灌洗液的CA153水平为(26.90±2.76)U/ml,低于乳头溢液导管镜检G3级的(31.91±22.95)U/ml,但差异无统计学意义(P>0.05);与G4级的(52.67±33.63)U/ml和G5级的(85.68±21.13)U/ml比较,差异均有统计学意义(P<0.05)。结论乳管镜直视下乳腺导管内活检是微创、安全、方便可行、成功率高的诊断方法,联合乳头灌洗液进行CA153检测对于诊断早期乳管内恶性病变有一定的参考价值。

Objective To investigate the value of fiberoptic ductoscopy-guided intraductal biopsy in combination with the detec- tion of biomarker CA153 in diagnosis of early ductal pathological changes. Methods From May 2012 to October 2014, fiberoptic ducto- scopy was performed on 123 nipple discharge patients, and patients diagnosed as breast intraductal neoplasm were given intraductal bio sy. The biopsy results were compared with pathology of duct excision. Nipple lavage fluid were collected from patients with intraductal neoplasm for the test of CA153, and 30 patients of intraductal dilatation were enrolled as control. Results Fifty-six patients who were found brest intraductal neoplasm among 123 patients underwent 64 times of fiberoptie ductoscopy-guided intraductal biospy and ductal lesions were removed. Among 56 patients underwent fiberoptic ductoscopy-guided intraductal biopsy, there were intraductal papilloma in 28 cases, mutiple intraductal papilloma in 7 cases, ductal hyperplasia in 6 eases, severe atypical duetal hyperplasias in 2 cases, and breast cancer was found in 7 cases. Biopsy failed in 6 patients, and the success rate of biopsy was 89. 3%. All the patients underwent breast duct dissection. There were solitary intraductal papilloma in 29 cases, multiple intraductal papilloma in 1 lcases, ductal hyperplasia in 8 cases, atypical ductal hyperplasia in 1 case, intraductal carcinoma in 4 cases, invasive ductal carcinoma in 2 cases and intraductal papilloma carcinoma in 1 case. CA153 level of nipple lavage fluid in intraductal dilatation patients was （26. 90±2.76）U/ml,lower than（ 31.91 ± 22.95） U/ml of G3 grade （P〉0. 05）, （52. 67±33.63）U/ml of G4 （P〈0. 05 ） and （85.68±21.13 ）U/ml of Gs grade （P〈0. 05 ）. Conclusion Fiberoptic ductoscopy-guided intradactal biopsy is microinvasive, safe, convenient with high success rate, and in combination with CA153 level in nipple lavage fluid shows certain values in diagnosing early ductal malignant changes.