Department of Radiology, Division of Breast Imaging, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
Radiographics. 2012 Jul-Aug;32(4):1009-30. doi: 10.1148/rg.324115150.
Ductal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal-lobular unit. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling.
导管疾病是乳腺影像学中一个重要但常被忽视且了解甚少的问题，可导致诊断和患者治疗的延误。导管内肿块的鉴别诊断广泛，包括浓稠分泌物、感染、出血、单发或多发乳头状瘤和恶性肿瘤。每个乳房由 8 个或更多的导管系统组成，大多数疾病发生在终末导管小叶单位。导管系统的影像学评估通常需要结合乳房 X 线摄影、乳管造影、超声（US）检查，在某些情况下还需要磁共振成像（MR）检查。所有检查方法中最常见的表现是导管扩张伴局灶或弥漫性异常。导管的良性疾病包括导管扩张症、导管阻塞、炎症浸润、导管周围乳腺炎、大汗腺化生、导管内乳头状瘤和乳头状瘤病。导管的恶性疾病包括导管原位癌、浸润性导管癌和派杰病。经皮活检方法最常与 US 或 MR 成像引导联合使用，有助于导管疾病的诊断和处理。由于大多数病变小于 1cm，位于导管内，因此单次通过时有时无法看到，真空辅助装置有助于提高取样的准确性。
