Richards T, Hunt A, Courtney S, Umeh H
Department of Surgery, Royal Berkshire Hospital, Reading, UK.
Ann R Coll Surg Engl. 2007 Mar;89(2):124-6. doi: 10.1308/003588407X155491.
Nipple discharge is regarded a sign of breast cancer. Type of discharge and cytology are unreliable for diagnosis. Most malignant cases have a detectable breast mass. The aim of this study was to assess the association between nipple discharge and breast cancer.
Patients who underwent operation for nipple discharge at a district general hospital (population 460,000) over a 3-year period were included. All had normal clinical, radiological and cytological examination. Operation and histopathology reports were reviewed.
Eighty-six patients underwent operation for nipple discharge. Median age was 54 years (range, 32-84 years). Analysis of nipple discharge revealed red blood cells (RBCs) in 35 patients (40%). At operation, 81 patients underwent radical sub-areola duct excision (Hadfield's procedure) and five microdochectomy. Histopathology reported duct ectasia in 59 patients and benign ductal papilloma in 25. Two patients had occult malignancy - DCIS (1) and LCIS (1). No invasive cancer was found.
Nipple discharge alone is not usually a sign of breast cancer. Occult malignancy is rare. A period of 'watchful waiting' may prevent patients undergoing unnecessary surgery.
乳头溢液被视为乳腺癌的一种体征。溢液类型和细胞学检查对于诊断并不可靠。大多数恶性病例可触及乳房肿块。本研究的目的是评估乳头溢液与乳腺癌之间的关联。
纳入在一家地区综合医院（人口46万）接受乳头溢液手术的患者，时间跨度为3年。所有患者的临床、放射学和细胞学检查均正常。对手术及组织病理学报告进行了回顾。
86例患者接受了乳头溢液手术。中位年龄为54岁（范围32 - 84岁）。对乳头溢液的分析显示，35例患者（40%）有红细胞（RBC）。手术时，81例患者接受了乳晕下导管根治性切除术（哈德菲尔德手术），5例接受了微小乳管切除术。组织病理学报告59例患者有导管扩张，25例有良性导管乳头状瘤。2例患者有隐匿性恶性肿瘤——导管原位癌（1例）和小叶原位癌（1例）。未发现浸润性癌。
单纯乳头溢液通常并非乳腺癌的体征。隐匿性恶性肿瘤罕见。一段时期的“观察等待”可避免患者接受不必要的手术。
