Xu Xiao-Zhou, Wang Jing, Wang Zhong-Zhao, Zhang Bo-Lin, Zhang Hong-Tu, Wang Xiang, Wei Yan-Hui, Zhang Bao-Ning
Department of Abdominal Surgical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2008 Mar;30(3):234-6.
To evaluate and compare localization by ductoscopy-guided wire with localization by conventional methods in the terminal duct excision for women with pathological nipple discharge.
Breast terminal duct excision were performed in 174 consecutive patients with intraductal lesions diagnosed by mammary ductoscopy. Sixty-eight of those underwent ductoscopy-guided wire localization for more accurate ductal excision. The patients received mammary ductoscopy and a hooked wire was anchored at the intraductal lesions under endoscopic surveillance just before the operation. Then a biopsy resection of wire-guided terminal duct and frozen section were done. Tbe other 106 patients received terminal duct excision under localization with conventional methods without ductoscopy either by puncturing a needle or injection of blue dye through the duct with pathological discharge.
Of the 68 patients with ductoscopy-guided duct excision, 64 had intraductal papillomas and 4 duct carcinoma in situ proved by pathology. All the lesions in these 68 patients were completely resected during biopsy without extra extended resection, and the concordance rate of the pathological result with ductoscopic diagnosis was 100.0%. None of them developed a postoperative breast distortion. In the conventional method localization group, there were 96 intraductal papilloma, 6 duct carcinoma in situ and 4 adenosis. Only 77.4% of the lesions were excised in the primary biopsy, and 22.6% needed extended resection. The concordance rate of the pathological diagnosis with ductoscopic diagnosis was 96.2%. Twenty-six patients had a deformed breast postoperatively.
Ductoscopy-guided wire localization is superior to the conventional localization method in the surgical terminal duct excision for women with spontaneous nipple discharge. It is not only helpful for more accurate localization and resection as well as pathologic sampling, but also is minimally invasive. Further studies are still required and this method may deserve to be popularized.
评估并比较在患有病理性乳头溢液的女性行终末导管切除术中，经乳管镜引导钢丝定位与传统方法定位的效果。
对174例经乳腺导管镜诊断为导管内病变的连续患者进行乳腺终末导管切除术。其中68例患者接受了乳管镜引导钢丝定位，以实现更精确的导管切除。这些患者接受了乳腺导管镜检查，并在手术前在内镜监测下将带钩钢丝固定在导管内病变处。然后进行钢丝引导下的终末导管活检切除及冰冻切片检查。另外106例患者采用传统方法定位，未进行导管镜检查，通过穿刺针或经有病理溢液的导管注射蓝色染料进行终末导管切除。
在68例行乳管镜引导导管切除的患者中，病理证实64例为导管内乳头状瘤，4例为导管原位癌。这68例患者的所有病变在活检时均被完整切除，无需额外扩大切除，病理结果与导管镜诊断的符合率为100.0%。无一例出现术后乳房变形。在传统方法定位组中：有96例导管内乳头状瘤，6例导管原位癌和4例腺病。初次活检时仅77.4%的病变被切除，22.6%的病变需要扩大切除。病理诊断与导管镜诊断的符合率为96.2%。26例患者术后出现乳房变形。
在患有自发性乳头溢液的女性行手术终末导管切除术中，乳管镜引导钢丝定位优于传统定位方法。它不仅有助于更精确的定位、切除及病理取样，而且具有微创性。仍需进一步研究，该方法可能值得推广。
