Okazaki A, Hirata K, Okazaki M, Svane G, Azavedo E
First Department of Surgery, Sapporo Medical University, Japan.
Eur Radiol. 1999;9(4):583-90. doi: 10.1007/s003300050715.
Nipple discharge disorders is a field in which there has been both increasing awareness on the part of patients and advances in management. Today secretion from nipples can be classified according to its color, cellularity and biology. To be significant a discharge should be true, spontaneous, persistent and non-lactational. Moreover there are methods to differentiate patients who require surgical intervention from those who do not. Surgically significant nipple discharges are watery, serous (yellow), serosanguineous and bloody. Cytology smears of discharge material have helped to classify the cellular material, providing information about normality, atypia and malignancy and also about papillary formation of the exfoliated cells. Tests such as Hemoccult help to discover occult blood in the secreted fluid. Modern immunological tests can be performed on cytology smears where occurrence of high levels of carcinoembryonic antigen could indicate a latent malignancy. Galactography investigation is today the state-of-the-art approach to investigate patients with nipple discharge disorders and this examination can demonstrate the size, location and extent of an intraductal abnormality. Modern high-resolution ultrasound techniques are helpful in visualizing intraductal disorders and are becoming a good complementary approach if not an alternative to traditional radiology techniques. Recently even MR galactography has been shown to be of diagnostic value, but not as informative as regular galactography. The most sophisticated investigation method, which can also be used therapeutically, is fiber-ductoscopy of the concerned duct in a breast. This technique, although expensive and in its infancy, is a fascinating and promising approach for inspecting the intraductal lumina. In this article the background, current investigation methods and possibilities of the technique are described, as well as the most sophisticated ways to deal with nipple discharge disorders in human breasts.
乳头溢液疾病是一个患者关注度不断提高且管理方法不断进步的领域。如今，乳头分泌物可根据其颜色、细胞成分和生物学特性进行分类。具有重要意义的溢液应是真性、自发性、持续性且非哺乳期的。此外，有方法可区分需要手术干预的患者和不需要手术干预的患者。具有手术意义的乳头溢液为水样、浆液性（黄色）、浆液血性和血性。溢液材料的细胞学涂片有助于对细胞材料进行分类，提供有关正常、异型和恶性情况的信息，以及有关脱落细胞乳头形成的信息。隐血试验等检查有助于发现分泌液中的潜血。现代免疫学检查可在细胞学涂片上进行，其中癌胚抗原水平升高可能提示潜在恶性肿瘤。乳腺导管造影检查是目前研究乳头溢液疾病患者的先进方法，该检查可显示导管内异常的大小、位置和范围。现代高分辨率超声技术有助于观察导管内疾病，即使不能替代传统放射学技术，也正成为一种很好的辅助方法。最近，磁共振乳腺导管造影也已显示具有诊断价值，但不如常规乳腺导管造影信息丰富。最复杂的检查方法，也可用于治疗，是对乳房相关导管进行纤维导管镜检查。这项技术虽然昂贵且尚处于起步阶段，但对于检查导管内腔来说是一种引人入胜且很有前景的方法。本文描述了该技术的背景、当前的检查方法和可能性，以及处理人类乳房乳头溢液疾病的最复杂方法。
