Kamali Sedat, Bender Omer, Kamali Gülcin Harman, Aydin Mehmet Timucin, Karatepe Oguzhan, Yuney Enis
Department of Surgery, SB Okmeydani Training and Research Hospital, Istanbul, Turkey,
Breast Cancer. 2014 Mar;21(2):154-61. doi: 10.1007/s12282-012-0377-7. Epub 2012 Jun 6.
Fiberoptic ductoscopy is a practical and direct approach that allows the visualization of intraductal breast disease. The aim of this study was to assess the efficacy of ductoscopy in the diagnosis and management of intraductal lesions.
Data on 357 ductoscopic investigations from patients with nipple discharge were collected prospectively. Seventy-five patients were diagnosed as having intraductal papillary lesions and these cases were evaluated by final histopathology (55 solitary, 14 multiple papillomatosis, 6 premalignant or malignant lesions). Results of classical diagnostic studies using ultrasonography, mammography, and galactography were compared with those of ductoscopy and pathology.
The sensitivities of investigation methods for papillomas in this study were 72 % in ultrasonography, 62.9 % in mammography, 81.4 % in galactography, and 86.6 % in ductoscopy. With ductoscopic papillomectomy (DP), almost 30 % of patient with solitary papilloma did not require further extensive surgery.
Since there is an increased risk of malignancy, surgical excision is recommended for multiple, larger papillomas and for papillomas with atypia and in addition for papillomas where diagnostic tools produce suspicious findings. On the other hand DP is a minimally invasive intervention and can aid in the follow-up of lesions proven to have no atypia.
纤维乳管镜检查是一种实用且直接的方法，可用于观察乳腺导管内疾病。本研究的目的是评估乳管镜在导管内病变诊断和治疗中的疗效。
前瞻性收集了357例乳头溢液患者的乳管镜检查数据。75例患者被诊断为导管内乳头状病变，并通过最终组织病理学进行评估（55例为孤立性乳头状瘤，14例为多发性乳头状瘤病，6例为癌前病变或恶性病变）。将超声、乳腺X线摄影和乳管造影等传统诊断研究的结果与乳管镜检查和病理学结果进行比较。
本研究中，乳头状瘤检查方法的敏感性分别为：超声72%，乳腺X线摄影62.9%，乳管造影81.4%，乳管镜检查86.6%。采用乳管镜下乳头状瘤切除术（DP），近30%的孤立性乳头状瘤患者无需进一步进行广泛手术。
由于恶性风险增加，对于多发性、较大的乳头状瘤以及具有异型性的乳头状瘤，此外对于诊断工具产生可疑结果的乳头状瘤，建议进行手术切除。另一方面，DP是一种微创干预措施，可有助于对经证实无异型性的病变进行随访。
