Yamamoto D, Shoji T, Kawanishi H, Nakagawa H, Haijima H, Gondo H, Tanaka K
Department of Surgery II, Kansai Medical University, Moriguchi, Osaka, Japan.
Breast Cancer Res Treat. 2001 Nov;70(2):103-8. doi: 10.1023/a:1012990809466.
Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. While ductography has been advocated as the main procedure in patients with nipple discharge, fiberoptic ductoscopy (FDS) is an emerging technique allowing direct visual access to the ductal system of the breast through nipple orifice exploration.
We applied ductography and FDS to 65 women who had nipple discharge, and compared their utility.
Intraductal lesions occurred in the segmental duct and the first, second, third, fourth, fifth, and sixth branches in decreasing frequency with ductography and FDS screening. The detection rates of intraductal abnormal lesions by ductography and FDS and the their combination were 89.1 (37 patients), 97.4 (38 patients), and 97.5% (39 patients) respectively. Ductal washings performed during FDS were effective to obtain representative exfoliated ductal cells which could be evaluated (sensitivity 50%, specificity 94.3%, and diagnostic accuracy 89.7%). As a result, we diagnosed 35 cases of benign lesions and four cases of malignant lesions by cytological or/and histological examination.
Ductography and fiberoptic ductoscopy are useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.
乳腺癌和癌前病变被认为始于乳腺导管或小叶的内衬。虽然导管造影术一直被提倡作为乳头溢液患者的主要检查方法，但纤维乳管镜检查（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65例有乳头溢液的女性应用了导管造影术和FDS，并比较了它们的效用。
导管造影术和FDS筛查显示，导管内病变在节段性导管以及第一、第二、第三、第四、第五和第六分支中的发生率呈递减趋势。导管造影术、FDS及其联合检查对导管内异常病变的检出率分别为89.1%（37例患者）、97.4%（38例患者）和97.5%（39例患者）。FDS检查期间进行的导管冲洗有效地获取了可评估的代表性脱落导管细胞（敏感性50%，特异性94.3%，诊断准确性89.7%）。结果，我们通过细胞学或/和组织学检查诊断出35例良性病变和4例恶性病变。
导管造影术和纤维乳管镜检查在指导后续乳腺手术治疗乳头溢液方面是有用的检查方法。
