Dinkel H P, Trusen A, Gassel A M, Rominger M, Lourens S, Müller T, Tschammler A
Department of Diagnostic Radiology, University of Würzburg, Germany.
Br J Radiol. 2000 Jul;73(871):706-14. doi: 10.1259/bjr.73.871.11089460.
The purpose was to identify features of malignant and non-malignant neoplastic breast disease on galactography and to estimate their predictive value. This is the largest reported study correlating galactographic morphological patterns with histopathology and the only blinded study. The study included 351 consecutive galactograms and 161 breast biopsies performed in patients with nipple discharge over a 10-year period. Three radiologists, blinded to clinical data and histological results, re-evaluated 158 previously performed galactograms of patients who had undergone excision biopsy. Extravasation or incomplete filling precluded reading in 9.5% of examinations. Among the remaining 143 examinations there were 11 cancers (7.7%), 56 papillomas (39.2%), 19 cases of intraductal papillomatous proliferation (13.3%), 55 cases of fibrocystic or secretory disease (38.5%) and two normals. A "filling defect/cut-off" pattern (n = 90) was found in 6 cancers (6.7%) and 58 cases of papilloma or papillomatous proliferation (64.4%). A "leafless tree" pattern was found only in benign cases (n = 12; 8.4%). In 32 of 143 cases (22.4%) a "ductal ectasia" pattern was present, in one case of which (3.1%) cancer was found. Cancer was identified in two of four cases with an "architectural distortion" pattern. Cancer is rare in patients with nipple discharge. A tendency towards a lower incidence of cancer associated with the "ductal ectasia" and "leafless tree" patterns was found. No statistical evidence was found to indicate that galactography provides an effective prospective diagnosis of malignancy. However, an abnormal galactogram strongly correlated (p < 0.001) with the presence of a breast neoplasm when both benign and malignant tumours were considered. The most important role played by galactography is in the localization of breast neoplasms and in the choice of appropriate surgical therapy.
本研究旨在识别乳腺导管造影中恶性和非恶性肿瘤性乳腺疾病的特征，并评估其预测价值。这是报道的将乳腺导管造影形态学模式与组织病理学相关联的最大规模研究，也是唯一一项双盲研究。该研究纳入了10年间因乳头溢液接受检查的351例连续乳腺导管造影病例及161例乳腺活检病例。3名对临床数据和组织学结果不知情的放射科医生对158例曾接受切除活检患者之前的乳腺导管造影进行了重新评估。9.5%的检查因造影剂外渗或充盈不完全而无法判读。在其余143例检查中，有11例癌症（7.7%）、56例乳头状瘤（39.2%）、19例导管内乳头状瘤样增生（13.3%）、55例纤维囊性或分泌性疾病（38.5%）以及2例正常情况。“充盈缺损/截断”模式（n = 90）见于6例癌症（6.7%）以及58例乳头状瘤或乳头状瘤样增生（64.4%）。“枯树”模式仅见于良性病例（n = 12；8.4%）。143例病例中有32例（22.4%）出现“导管扩张”模式，其中1例（3.1%）为癌症。4例“结构扭曲”模式的病例中有2例发现癌症。乳头溢液患者中癌症少见。发现与“导管扩张”和“枯树”模式相关的癌症发生率有降低趋势。未发现统计学证据表明乳腺导管造影能有效进行恶性肿瘤的前瞻性诊断。然而，当同时考虑良性和恶性肿瘤时，异常乳腺导管造影与乳腺肿瘤的存在密切相关（p < 0.001）。乳腺导管造影最重要的作用在于乳腺肿瘤的定位以及合适手术治疗方式的选择。
