乳管镜辅助乳管冲洗液薄层液基细胞学检查诊断乳头溢液的研究  

Intraductal aspiration TCT by Fiberoptic ductoscopy for patients with nipple discharge

作　　者：张安秦[1] 王颀[1] 张江宇[2] 许娟[1] 李文萍[1] 陈中扬[1] 杨剑敏[1] 朱彩霞[1] 施军涛[1] 翁秀琼[1] 

机构地区：[1]广州医学院附属广东省妇儿医院乳腺病中心,510010 [2]广州医学院附属广东省妇儿医院病理科,510010

出　　处：《中华乳腺病杂志（电子版）》2007年第2期19-21,共3页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：广东省医学科研基金课题(B2004017)

摘　　要：目的探讨乳管镜(FDS)检查中冲洗液薄层液基细胞学(TCT)检查辅助诊断乳头溢液病因的价值。方法对2004年4月至2006年6月间107例乳头溢液患者进行FDS和冲洗液TCT检查,79例接受手术活检和治疗,将各种检查与病理检查结果进行对照研究。结果 FDS下确定30例乳头溢液患者,乳管内隆起型病变的占77例,位于三级以下乳管占88.3%。FDS和TCT检查总符合率为74.7%和81.0%,病变在二级导管以上FDS和TCT检查符合率为86.7%和76.7%,三级以下导管,两种检查符合为67.3%和83.7%;FDS和TCT检查诊断多发乳头状瘤符合率、阳性试验似然比(likelihood ratio of a positivetest,LR)分别为60.3%、3.67和84.2%、4.46;FDS和TCT检查诊断乳腺癌符合率、LR分别为66.7%、1.46和100%、6.84。TCT或FDS联合后对恶性病变诊断阳性试验似然比(LR)可达25.5。结论二级以上乳管病变FDS检查准确性高,三级以下辅助乳管冲洗液TCT检查,提高乳头溢液诊断准确性。对于FDS诊断疑难的病例两者联合有助于提高良恶性病变的鉴别诊断。Objective To evaluate the value of intraductal aspiration ThinPrep Cytology Test （TCT） by fiberoptic ductoseopy （FDS） in the diagosis of nipple discharge. Methods FDS, intraductal aspiration TCT by FDS were used to diagnose and examine 107 patients with confused nipple discharge during April 2004 to June 2006 ; 79 patients were treated operatively. The results of diagnosis and biopsy pathology were studied. Results Using FDS 107 patients with nipple discharge were diagnosed. 77 were detected to have intraduetal tumor, and 88..3% was below the third branch duct. The over accuracy of FDS and TCT was 74.7% and 81.0%. The accuracy of FDS and TCT was 86.7% and 76.7% over the second branch duct. But the first branch duct and the second branch duct accounted for 67.3% and 83.7%. The accuracy, sensitivity and specificity were 60.3% , 81. 4% and 77.8% for intraduetal papillomas, and those of TCT were 84.2%, 7 4.4% and 83.3% , respectively. And their Likelihood ratio of a positive test （LR） was 3.67 and 4.46, that of FDS for breast cancer was 66.7%, 31.6% and 78.3%, and that of TCT was 100%, 68.4% and 90%, respectively. FDS and TCT were used together to diagnose breast cancer , and the sensitivity and specificity were improved to 84.2% and 96.7%. And their LR was 1.46 and 6.84, LR of combined use of the two means to diagnose breast cancer reached 25.5. Conclusions FDS is a good method to diagnose nipple discharge of the first branch and the second branch. But for the third branch, combine use of FDS with TCT can improve the accuracy and decrease false-negative rate of nipple discharge. It is helpful in differentiating malgnant from benign discharge.

关 键 词：乳头溢液 内窥镜 细胞学 诊断 

分 类 号：R655.8[医药卫生—外科学] R814.43[医药卫生—临床医学]