中国实用外科杂志

中国实用外科杂志

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乳管镜对以病理性乳头溢液为首发症状乳腺癌诊断价值分析

杨舒涵1，温    健1，窦怀豹2，涂    巍1   

  1. 1中国医科大学附属第四医院普通外科，辽宁沈阳 110032；2塔城地区人民医院普通外科，新疆维吾尔自治区塔城地区 834700
  • 出版日期:2020-10-01 发布日期:2020-10-19

  • Online:2020-10-01 Published:2020-10-19

摘要： 目的    评估乳管镜在以病理性乳头溢液为首发症状乳腺癌中的诊断价值。方法    回顾性分析2016年8月至2019年8月中国医科大学附属第四医院（380例）和新疆塔城地区人民医院（30例）收治的共410例以病理性乳头溢液为首发症状病人的临床资料，所有病人术前均行乳管镜、超声及钼靶检查。分析乳管镜检查中与乳腺癌诊断密切相关的因素，比较不同检查方式对乳腺癌诊断的敏感度、特异度、阳性预测值及阴性预测值。结果    410例病人均接受手术治疗，并进行术后病理学诊断，其中乳腺癌31例（7.6%）。乳管镜检查结果中，良性病例与恶性病例的溢液颜色、溢液量及病灶深度差异有统计学意义（P<0.05）。乳管镜对于乳腺癌术前评估诊断的敏感度为90.3%，明显高于超声（61.3%）和钼靶检查（48.4%），三者特异度差异无统计学意义（P>0.05）。超声联合钼靶检查敏感度为71.0%，而在此基础上联合乳管镜检查可使诊断的敏感度提高至93.5%。结论  在以病理性乳头溢液为首发症状乳腺癌的诊断中，乳管镜检查的敏感度显著高于超声和钼靶，增加乳管镜检查能够显著提高乳腺癌诊断的敏感度，避免漏诊。

关键词: 病理性乳头溢液, 乳腺癌, 乳管镜, 超声, 钼靶

Abstract: The diagnostic value of ductoscopy in breast cancer patients with pathological nipple discharge as the earliest presenting symptom        YANG Shu-han，WEN Jian，DOU Huai-bao，et al. Department of General Surgery，the Fourth Affiliated Hospital of China Medical University，Shenyang 110032，China
Corresponding author：TU Wei，E-mail：cmu4htw@126.com
Abstract    Objective    To evaluate the diagnostic value of ductoscopy in breast cancer with pathological nipple discharge as the earliest presenting symptom. Methods    The clinical data of 410 patients with pathological nipple discharge who received surgical treatment in the Fourth Affiliated Hospital of China Medical University (380 cases) and Xinjiang Tacheng Region People's Hospital (30 cases) were analyzed retrospectively. All patients received ductoscopy，ultrasound and mammography before surgery. The factors which were closely related to the diagnosis of breast cancer were analyzed. The sensitivity，specificity，positive predictive value and negative predictive value of various examination methods in the diagnosis of breast cancer were compared. Results    Surgical treatment and pathological diagnosis were achieved for all 410 patients.，including 31 breast cancer (7.6%). The discharge color，discharge volume and depth of the lesions were significantly different between benign and malignant cases（P<0.05）. For patients with breast cancer confirmed by pathology，the sensitivity of ductoscopy was 90.3%，which was significantly higher than ultrasound (61.3%) and mammography (48.4%). The sensitivity of ultrasound combined with mammography was 71.0%，and the sensitivity of ductoscopy combined with ultrasound and mammography can be further improve to 93.5%. Conclusion    In the diagnosis of breast cancer with pathological nipple discharge as the earliest presenting symptom，the sensitivity of ductoscopy is significantly higher than ultrasound and mammography，and adding ductoscopy can significantly improve the diagnostic sensitivity of breast cancer and avoid missed diagnosis.

Key words: pathological nipple discharge, breast cancer, ductoscopy, ultrasound, mammography