106例病理性乳头溢液(PND)临床分析  

A retrospective analysis of 106patients with pathological nipple discharge(PND)

作　　者：王富文[1] 林燕苹[2] 何萍青[2] 

机构地区：[1]复旦大学附属妇产科医院乳腺外科,上海200011 [2]上海交通大学附属第六人民医院乳腺外科,上海200233

出　　处：《复旦学报（医学版）》2013年第6期714-717,共4页Fudan University Journal of Medical Sciences

摘　　要：目的探讨分析106例病理性乳头溢液(pathological nipple discharge,PND)的临床特点,为其诊断和治疗提供依据。方法收集本院2007至2011年106例PND患者的基本信息、影像学结果、乳腺导管镜下所见和术后病理结果,并进行统计分析。结果 106例患者中血性溢液72例(68%),非血性溢液34例(32%)。病理结果:囊性增生、炎症、导管扩张症35例(33%),导管内乳头状瘤51例(48.1%),导管内乳头状瘤病伴导管上皮不典型增生11例(10.4%),导管原位癌6例(5.7%),神经内分泌癌3例(2.8%)。血性溢液患者在导管镜下新生物率和不典型增生/恶性率高于非血性溢液患者(P=0.019和P=0.004),而两者影像学表现的差异无统计学意义(P=0.656)。20例不典型增生和恶性患者中,导管镜下新生物发现率明显高于影像学检查(IV/V)异常率(P=0.013);导管镜下未见新生物且影像学表现为I/II/III的有3例(15%)。结论无论影像学和/或导管镜的检查结果如何,对PND尤其血性溢液患者有必要进行组织学活检。Objective To investigate the clinical features of pathological nipple discharge （PND） ,and to provide the basis for the rational clinical diagnosis and treatment. Methods We reviewed data of 106 patients who enrolled and underwent duetoseopy for PND from 2007 to 2011. Data included patient and imaging characteristics, indications, duetoscopic findings and pathologic outcomes. Statistical analysis was used for data summary. Results All of the patients underwent ductoscopy and directed duct excision for pathologic nipple discharge,including 72 cases （68%） with bloody discharge and 34 cases （32%） with unbloody discharge. Final pathology revealed duct eetasia and associated benign findings in 35 cases （33%）, papillomas in 51 cases （48. 1%）, papillomatosis with atypical ductal hyperplasia in 11 cases （10.4%）, ductal carcinoma in situ （DCIS） in 6 cases （5. 7%）, and neuroendocrine carcinoma in 3 cases （2.8 %）. Compared with unbloody discharge,patients with bloody discharge showed higher rate of intraductal neoplasm in ductoscopy and atypical ductal hyperplasia （ADH）/malignant （P = 0. 019,P = 0. 004）, but didnlt show significant difference in breast imagingfindings （P= 0. 656）. In 20 patients with atypical ductal hyperplasia （ADH）/malignant, the rate of intraductal neoplasm under ductoscopy was higher than that of BI-RADS category Ⅳ/Ⅴ findings （P = 0. 013）. There were 3 patients （15%） whom were not found intraductal neoplasm under ductoscopy and were found BI-RADS category Ⅰ/Ⅱ/Ⅲ. bloody discharge, a tissue diagnosis should findings. Conclusions When a patient has true PND especially be warranted regardless imaging and/or ductoscopic

关 键 词：病理性乳头溢液(PND) 乳腺导管镜 乳腺疾病 

分 类 号：R655.8[医药卫生—外科学]