纤维乳腺导管镜下碘染色对导管内增生性病变的诊断研究  

The Study of Fiberoptic Duct Endoscopy (FDS) Iodine Staining for the Diagnosis of Intraductal Proliferative Lesions

作　　者：冯鑫至[1] 张凤霞[1] 林晓燕[2] 梅红[1] 赵斌[1] 

机构地区：[1]山东省医学影像学研究所,250021 [2]山东省立医院病理科

出　　处：《天津医药》2012年第12期1185-1187,I0007,I0008,共5页Tianjin Medical Journal

基　　金：山东省科技发展计划项目(项目编号:2011GGH21815);山东省医药卫生科技发展计划项目(项目编号:2011QW026)

摘　　要：目的:探讨纤维乳腺导管镜(FDS)下碘染色对乳腺导管内增生性病变的诊断价值及其临床意义。方法:选择177例乳头溢液患者行FDS检查,随机分为2组,碘染色组92例行FDS下Lugol氏液染色,对照组85例行常规FDS检查而不进行碘染色。对可疑病变做导丝定位后手术切检,病理结果作为金标准,评价FDS下Lugol氏液碘染色对导管内增生性病变的诊断价值。结果:乳腺普通型增生病标本体外碘染色后呈棕褐色,而乳腺导管原位癌标本染色后染色显著变浅或不着色。碘染色组和对照组对导管上皮内瘤变(DIN)的诊断符合率分别是97.82%和88.24%;敏感度分别是98.83%和89.16%;特异度分别是83.33%和50%;阳性似然比分别是5.93和1.78;阴性似然比分别是0.014和0.217;约登指数分别是0.822和0.392。碘染色组敏感度、特异度和诊断符合率均高于对照组。结论:FDS下碘染色对DIN的诊断优于常规的FDS检查,该方法值得推广应用。Objective： To investigate the diagnostic value and clinical significance of fiberoptic duct endoscopy （FDS） iodine staining for the intraductal proliferative lesions. Methods：One hundred and seventy-seven patients with nipple discharge were included in this study. Patients were randomly divided into two groups and detected by FDS. Ninety-two patients were conducted Lugol＇s solution staining under FDS （iodine staining group）. Eighty-five patients were carried out routine FDS check without iodine staining （control group）. All of suspicious lesions were cut and inspected with wire positioning, thus evaluating the clinical significance of Lugol＇s iodine staining for the diagnosis of intraductal proliferative lesions. Results：PAS staining was positive in mammary gland hyperplasia while PAS positive substance was gradually eliminated until the neglectable level. Mammary gland hyperplasia specimens took on a color of tan brown after supravital staining whereas the color of breast cancer samples after staining became significantly lighter or unstained. The diagnostic agreement rates were 97.82% and 88.24% for ductal intraepithelial neoplasia （DIN） of iodine staining group and control group respectively. The sensitivity was 98.83% and 89.16% in the two groups respectively, and the specificity was 83.33% and 50% respectively. The positive likelihood ratio was 5.93 and 1.78 respectively. The negative likelihood ratio was 0.014 and 0.217 respectively. Youden index was 0.822 and 0.392 respectively. The sensitivity and diagnostic coincidence were significantly higher in iodine staining group than those of control group （P 〈 0.05）. Conclusion ：The diagnosis for DIN of iodine staining under FDS is superior to the conventional FDS. This approach deserves to be widely applied.

关 键 词：乳腺纤维囊性病 癌 癌 导管 乳腺 乳腺肿瘤 内窥镜检查 诊断 鉴别 敏感性与特异性 

分 类 号：R737.9[医药卫生—肿瘤]