Shen K W, Wu J, Lu J S, Han Q X, Shen Z Z, Nguyen M, Shao Z M, Barsky S H
Department of Surgery, Cancer Hospital/Cancer Institute, Shanghai Medical University, Shanghai, Peoples Republic of China.
Cancer. 2000 Oct 1;89(7):1512-9.
Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule, yet until recently, we have not had direct access to this area other than by blindly removing tissue by core biopsy or fine-needle aspiration. Fiberoptic ductoscopy (FDS) is an emerging technique allowing direct visual access to the ductal system of the breast through nipple orifice exploration.
We applied ductoscopy to 259 women who had nipple discharge, and we analyzed the visual findings, the cytological washings, and the subsequent histopathology.
In 92 (36%) of these women, fiberoptic ductoscopy was successful in detecting an intraductal papillary lesion. Of these observed lesions, 68 (74%) were single papilloma, 21 (23%) were multiple discrete papillomas, and 3 (3%) were diffuse intraductal thickening which corresponded to diffuse papillomatosis on histopathological analysis. The overall positive predictive value of FDS screening was 83%. Of the lesions observed, 29.8% were located in the main (segmental) duct, 43.9% lesions in the first branch, 17.5% lesions in the second branch, 7.9% in the third branch, and 0.9% in the fourth branch. These lesions had an overall average distance of 2.7 cm from the nipple orifice. Ductal washings performed at the time of ductoscopy were effective at obtaining representative exfoliated ductal cells which could be evaluated for the presence of clumps (> 50 cells), clumps with atypia or single ductal cells. The presence of clumps with positive FDS increased the positive predictive value to 86%.
Fiberoptic ductoscopy currently offers a safe alternative to ductography in guiding subsequent breast surgery in the treatment of nipple discharge.
乳腺癌及癌前病变被认为始于乳腺导管或小叶的内衬，但直到最近，除了通过粗针活检或细针穿刺盲目取材外，我们还无法直接获取该区域的组织。纤维乳管镜检查（FDS）是一种新兴技术，可通过乳头开口探查直接观察乳腺导管系统。
我们对259例有乳头溢液的女性进行了乳管镜检查，并分析了直视结果、细胞学冲洗液及后续组织病理学检查结果。
在这些女性中，92例（36%）通过纤维乳管镜成功检测到导管内乳头状病变。在这些观察到的病变中，68例（74%）为单发乳头状瘤，21例（23%）为多发散在乳头状瘤，3例（3%）为弥漫性导管内增厚，组织病理学分析显示为弥漫性乳头状瘤病。FDS筛查的总体阳性预测值为83%。在观察到的病变中，29.8%位于主（段）导管，43.9%位于一级分支，17.5%位于二级分支，7.9%位于三级分支，0.9%位于四级分支。这些病变距乳头开口的平均距离为2.7 cm。乳管镜检查时进行的导管冲洗有效地获取了具有代表性的脱落导管细胞，可对其进行团块（>50个细胞）、异型团块或单个导管细胞的评估。FDS阳性的团块的存在将阳性预测值提高到86%。
在指导后续乳腺手术治疗乳头溢液方面，纤维乳管镜检查目前为乳管造影提供了一种安全的替代方法。
