Simmons Rache, Adamovich Tara, Brennan Meghan, Christos Paul, Schultz Mimi, Eisen Carolyn, Osborne Michael
Weill Cornell Breast Center, Department of Surgery, New York, New York, USA.
Ann Surg Oncol. 2003 Mar;10(2):113-6. doi: 10.1245/aso.2003.03.089.
Nipple discharge is a common breast complaint. Because most nipple discharge is a result of benign processes, less-invasive, nonsurgical diagnostic modalities have been explored to reduce the need for surgical intervention.
Between September 1994 and December 2000, 108 female patients aged 25 to 77 years underwent duct excision for bloody or clear nipple discharge. Results of various preoperative studies were compared with surgical pathology to determine the sensitivity, specificity, positive predictive value, and negative predictive value of these tests in detecting malignant ductal pathology.
Of the 108 surgical histopathology specimens, 90 of 108 patients were benign, 5 of 108 patients were atypical, and 13 of 108 patients were malignant. The sensitivity of mammography was 57.1%, specificity was 61.5%, positive predictive value was 16.7%, and negative predictive value was 91.4%. Hemoccult sensitivity was 50%, specificity was 0%, positive predictive value was 20%, and negative predictive value was 0%. The sensitivity of ductography was 0%, specificity was 90%, positive predictive value was 0%, and negative predictive value was 81.8%. The sensitivity of cytology was 11.1%, specificity was 96.3%, positive predictive value was 50%, and negative predictive value was 76.5%.
Preoperative evaluations by mammography, Hemoccult, ductography, and cytology are poor predictors of histological diagnosis. These data suggest that patients with pathologic nipple discharge should undergo surgical biopsy for accurate diagnosis.
乳头溢液是常见的乳腺问题。由于大多数乳头溢液是良性病变所致，因此人们探索了侵入性较小的非手术诊断方法，以减少手术干预的需求。
1994年9月至2000年12月期间，108例年龄在25至77岁之间的女性患者因血性或清亮乳头溢液接受了导管切除术。将各种术前检查结果与手术病理结果进行比较，以确定这些检查在检测恶性导管病变方面的敏感性、特异性、阳性预测值和阴性预测值。
在108份手术组织病理学标本中，108例患者中有90例为良性，108例患者中有5例为非典型性，108例患者中有13例为恶性。乳腺钼靶检查的敏感性为57.1%，特异性为61.5%，阳性预测值为16.7%，阴性预测值为91.4%。潜血检查的敏感性为50%，特异性为0%，阳性预测值为20%，阴性预测值为0%。导管造影的敏感性为0%，特异性为90%，阳性预测值为0%，阴性预测值为81.8%。细胞学检查的敏感性为11.1%，特异性为96.3%，阳性预测值为50%，阴性预测值为76.5%。
乳腺钼靶检查、潜血检查、导管造影和细胞学检查对组织学诊断的预测效果不佳。这些数据表明，有病理性乳头溢液的患者应接受手术活检以获得准确诊断。
