不同临床及影像学特征对良恶性乳头溢液疾病鉴别诊断价值分析

Value analysis of different clinical and imaging features in the diagnosis of benign and malignant nipple discharge

目的探讨不同临床及影像学特征对良性及恶性乳头溢液疾病的诊断价值。方法回顾性分析2011年1月至2016年2月上海交通大学医学院附属瑞金医院因乳头溢液行手术治疗的233例病人的临床资料。乳腺癌33例(14.2%),乳腺良性疾病200例(85.8%)。分析不同临床及影像学特征病人良性及恶性乳头溢液的检出率,计算乳腺X线摄影、乳腺超声、乳腺MRI及联合检查对乳腺癌诊断的灵敏度。结果血性溢液(P=0.008)、乳腺X线摄影伴可疑恶性钙化(P<0.001)、MRI表现为段样强化(P=0.003)、流出型时间-信号强度曲线(P=0.023)的病人乳腺癌检出率明显增高,差异有统计学意义。乳腺X线摄影对恶性乳头溢液诊断的灵敏度较低(57.6%),劣于超声检查(87.9%,P=0.012)及MRI检查(93.9%,P=0.001)。乳腺X线摄影联合超声或MRI诊断的灵敏度分别为90.9%及100.0%,显著高于单用乳腺X线检查(P=0.004,P<0.001)。结论对于不伴肿块的乳头溢液,血性溢液、乳腺X线摄影伴可疑恶性钙化、MRI段样强化、时间-信号强度曲线为流出型的病人患乳腺癌的风险较高。乳腺X线摄影对乳头溢液潜在恶性病变的检出率较低,联合超声或MRI检查可提高检出率。

Abstract Objective To analyze the value of different clinical and imaging features in the diagnosis of benign and malignant nipple discharge. Methods The clinical data of 233 patients treated with surgery for nipple discharge from January 2011 to February 2016 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. A total of 233 cases without palpable mass were enrolled in the analysis. Thirty-three patients （14.2%） were diagnosed as breast cancer, and the other 200 patients （85.8%） were diagnosed as benign disease. The sensitivity, specificity, negative predictive value （NPV）, and positive predictive value （PPV） of mammogram, ultrasound, MRI and their combination in predicting malignant disease were calculated. Results Patients with bloody nipple discharge （P=0.008）, with suspicious calcification on mammography （P〈0.001）, with segmental enhancement （P=0.003） or with washout-patteru kinetic curve （P=0.023） on MRI had higher risk of breast cancer. The sensitivity of mammography in diagnosing breast cancer was 57.6%, significantly lower than that of ultrasound （87.9%,P=0.012） and MRI （93.9%, P=0.001）. The sensitivity of mammography combined with ultrasound or with MRI was 90.9% and 100% respectively, significantly higher than that of mammography alone （P=0.004, P〈0.001） .Conclusion Bloody nipple discharge, with suspicions calcification on mammography, with segmental or with washout-pattern kinetic curve on MRI are risk factors for predicting breast cancer in patients with nipple discharge without palpable disease. The sensitivity of breast cancer can be elevated with ultrasound or MRI comparing with mammography alone.