乳管内窥镜风险分级在乳头溢液诊疗中的应用  

Application of mammary ductoscopy risk classification in the diagnosis and treatment of nipple discharge

作　　者：范拥国 刘静 王改娟 杨晓民 王虎霞 陈楠 贺赛 侯艳妮 赵静 张静远 韩丕华 Fan Yongguo;Liu Jing;Wang Gaijuan;Yang Xiaomin;Wang Huxia;Chen Nan;He Sai;Hou Yanni;Zhao Jing;Zhang Jingyuan;Han Pihua(Ward 2 in Department of Breast Oncology,Shaanxi Provincial Cancer Hospital,Xi′an 710061,China)

机构地区：[1]陕西省肿瘤医院乳腺二病区,西安710061

出　　处：《中华转移性肿瘤杂志》2024年第6期546-552,共7页Chinese Journal of Metastatic Cancer

基　　金：陕西省科技厅重点研发项目(2023-YBSF-078);陕西省卫生健康科研基金项目(2022A010);西安市科技计划项目(2024JH-YLYB-0152);陕西省肿瘤医院院内国家自然科学基金孵育项目(SC23A08)。

摘　　要：目的评估乳管内窥镜风险分级在乳头溢液诊疗中的价值。方法回顾性分析2017—2023年因乳头溢液行乳管内窥镜检查后手术治疗的687例患者的临床资料,通过手术病理验证及对部分患者的长期随访验证,评估乳管内窥镜风险分级对溢液乳管评估的准确性。同时评估乳管内窥镜风险分级对乳腺癌诊断的敏感性、特异性、阳性预测值、阴性预测值及准确度,并采用受试者工作特征(ROC)曲线对其进行验证。结果687例乳头溢液患者中101例为乳腺癌患者,其中3类16例(恶性率2.9%)、4类47例(恶性率为61.0%)、5类37例(恶性率为88.1%)、6类1例(恶性率为100%)。乳管内窥镜风险分级对乳腺癌诊断的敏感性为84.2%、特异性为94%、阳性预测值为70.8%、阴性预测值为97.2%、准确度为92.6%。ROC曲线下面积为0.826(P<0.001)。结论乳管内窥镜风险分级对乳头溢液患者乳腺癌发生风险的评估是有效的,对乳头溢液患者的诊疗具有较高的指导价值。Objective To evaluate the value of mammary ductoscopy risk classification in the diagnosis and treatment of nipple discharge.Methods The clinical data of 687 patients who underwent mammary ductoscopy for nipple discharge from 2017 to 2023 were analyzed retrospectively.The accuracy of mammary ductoscopy risk classification in the assessment of leaking mammary ducts was evaluated through surgical pathologic verification and long-term follow-up verification of some patients.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of mammary ductoscopy risk classification in the diagnosis of breast cancer were evaluated and verified by receiver operating characteristic(ROC)curve.Results 101 of the 687 patients with nipple discharge had breast cancer,including 16 in category 3(malignant rate 2.9%),47 in category 4(malignant rate 61.0%),37 in category 5(malignant rate 88.1%),and 1 in category 6(malignant rate 100%).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of mammary ductoscopy risk classification for the diagnosis of breast cancer were 84.2%,94%,70.8%,97.2%,and 92.6%,respectively.The area under ROC curve was 0.826(P<0.001),which was statistically significant.Conclusion The mammary ductoscopy risk classification is effective in evaluating the risk of breast cancer in patients with nipple discharge,and has a high guiding value for the diagnosis and treatment of these patients.

关 键 词：乳管内窥镜 风险分级 乳头溢液 

分 类 号：R73[医药卫生—肿瘤]