Department of Surgery, County Hospital Pozega, Pozega, Croatia.
Arch Gynecol Obstet. 2011 Apr;283(4):851-4. doi: 10.1007/s00404-010-1481-6. Epub 2010 May 11.
There is a debate in the literature whether a pathologic nipple discharge is a distinct sign of breast carcinoma. Our own results obtained by the use of microdochectomy as a minimally invasive operative procedure in 184 patients with pathologic nipple discharge were analysed. The aim of this retrospective 20-year study was to assess the efficacy of microdochectomy in detecting early stages of intraductal breast carcinoma.
The study included data on 184 patients aged 24-77 years (median 46.6) divided into two groups of premenopausal (n = 123) and postmenopausal (n = 61) women. There were 139 patients with unilateral single-duct sanguinolent discharge and 45 patients with other types of nipple discharge. The operative procedure consisted of the discharging duct excision by use of a guide probe, preceded by cytology and ductography studies.
Histopathology of the excised ducts revealed only three carcinomas in premenopausal women and ten carcinomas in postmenopausal women. In a total of 13 carcinomas, there were 4 ductal carcinomas in situ, detected in patients aged 41-72 (median 66) years. Twelve carcinomas were associated with sanguinolent nipple discharge. Papilloma was the most common histology finding (56.5%).
Results of the study suggested mainly the association of sanguinolent single-duct nipple discharge and papilloma, whereas the rate of malignancies detected (7.0%) was consistent with literature reports. Microdochectomy proved to be a highly efficient operative method free from any impairment of the breast integrity. Conservative treatment with close clinical monitoring of the patient with cytology and ultrasonographic assessment might be possible in selected cases.
文献中存在关于病理性乳头溢液是否为乳腺癌特异体征的争论。我们分析了使用微创小切口切除术对 184 例病理性乳头溢液患者的研究结果。本回顾性 20 年研究旨在评估微切检术在检测乳腺导管内癌早期病变中的作用。
研究纳入了年龄 24-77 岁（中位年龄 46.6 岁）的 184 例患者，分为绝经前组（n=123）和绝经后组（n=61）。139 例患者为单侧单导管血性溢液，45 例为其他类型乳头溢液。手术过程包括使用引导探针切除溢液导管，术前进行细胞学和乳管造影检查。
切除导管的组织病理学检查仅发现 3 例绝经前妇女和 10 例绝经后妇女的乳腺癌。在总共 13 例癌中，有 4 例导管原位癌，患者年龄为 41-72 岁（中位年龄 66 岁）。12 例癌与血性乳头溢液有关。组织学上最常见的发现是乳头瘤（56.5%）。
研究结果主要提示血性单导管乳头溢液与乳头瘤有关，而检出的恶性肿瘤率（7.0%）与文献报道一致。微切检术是一种高效的手术方法，不会损害乳房完整性。在选择病例时，对患者进行密切的临床监测、细胞学和超声评估，可能可行保守治疗。
