Ashfaq Awais, Senior Derek, Pockaj Barbara A, Wasif Nabil, Pizzitola Victor J, Giurescu Marina E, Gray Richard J
Department of Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, USA.
Am J Surg. 2014 Aug;208(2):222-7. doi: 10.1016/j.amjsurg.2013.12.035. Epub 2014 Apr 3.
Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients.
Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorithm.
A total of 192 patients, mean age 56 years, were studied. Risk of carcinoma among the entire cohort was 5%. Breast surgeon was consulted for 142 (74%) patients: 48 (34%) underwent initial subareolar excision and 94 (66%) were clinically followed. The rate of carcinoma was 17% (8/48) after initial subareolar excision, 0% (0/13) for those without imaging abnormalities, 23% (8/35) with imaging abnormalities, and 1% (1/94) with clinical follow-up. Of patients who underwent follow-up, 21% (n = 20) underwent subareolar excision because of imaging abnormality (n = 1, 1%) or persistent discharge (n = 19, 20%). Most patients had ductal carcinoma in situ (n = 5, 56%).
Patients with nipple discharge can be prospectively identified based on radiographic findings and clinical examination for safe clinical follow-up. Most will have resolution avoiding a surgical procedure.
2%至5%的女性会出现乳头溢液。我们评估了先前提出的针对这些患者的治疗算法的有效性。
2005年至2011年期间，根据该算法，对有病理性乳头溢液且乳房X线摄影和乳晕下超声检查结果为阴性的患者进行随访。
共研究了192例患者，平均年龄56岁。整个队列中患癌风险为5%。142例（74%）患者咨询了乳腺外科医生：48例（34%）接受了初始乳晕下切除术，94例（66%）进行了临床随访。初始乳晕下切除术后的癌变率为17%（8/48），无影像学异常者为0%（0/13），有影像学异常者为23%（8/35），临床随访者为1%（1/94）。在接受随访的患者中，21%（n = 20）因影像学异常（n = 1，1%）或持续性溢液（n = 19，20%）接受了乳晕下切除术。大多数患者为导管原位癌（n = 5，56%）。
乳头溢液患者可根据影像学检查结果和临床检查进行前瞻性识别，以进行安全的临床随访。大多数患者的症状会自行缓解，无需手术。
