Grunwald Susanne, Bojahr Bernd, Schwesinger Gunther, Schimming Annette, Kohler Gunter, Schulz Karen, Ohlinger Ralf
Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt-University, Greifswald, and Clinic of Minimally Invasive Surgery, Evangelic Hospital Hubertus, Berlin, Germany.
J Minim Invasive Gynecol. 2006 Sep-Oct;13(5):418-23. doi: 10.1016/j.jmig.2006.05.004.
To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques.
Canadian Task Force classification III.
Interdisciplinary Breast Unit of a university hospital.
Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge.
Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy.
Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n=8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found.
Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.
描述乳腺导管内镜检查的性能，并将该方法与传统诊断技术进行比较。
加拿大工作组III级分类。
大学医院的跨学科乳腺科。
连续且未经挑选的15名女性患者系列，包括20个有乳头溢液的乳房。
对2003年4月至2004年4月间所有因乳头溢液接受导管镜检查的患者进行前瞻性数据评估。对所有术前（乳房X线摄影、超声检查、乳头涂片）和微创（乳腺导管造影、细针穿刺细胞学检查）诊断方法进行评估，并与导管镜检查结果进行比较。
20个乳房的乳房X线摄影显示BI-RADS-I级（5%）、BI-RADS-II级（50%）和BI-RADS-III级（45%）。乳腺超声扫描均显示异常，均归类为BI-RADS-III级等效病变。乳头涂片显示69.2%的细胞学检查正常，大多数病例后来发现为乳头状瘤（n = 8/9）。46.7%有自发性乳头溢液的患者进行了单侧乳腺导管造影。2例乳腺导管造影结果无异常，开放活检显示1例非典型导管增生和乳头状瘤。在15名女性的20个乳房上，成功进行了19例导管镜检查（95%）。17例在导管镜检查后进行了开放活检，发现1例原位导管癌（DCIS）、3例非典型导管增生（ADH）、1例无 atypias的导管增生和12例导管乳头状瘤。
与乳头涂片相比，本研究中导管镜检查的诊断价值更高，但略低于乳腺导管造影和高度专业化的乳腺超声扫描。因此，需要更大规模地评估导管镜检查，最好是在多中心试验中进行，以进一步确定其潜力和适应证。
