Bahl Manisha, Baker Jay A, Greenup Rachel A, Ghate Sujata V
1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
2 Department of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, Duke University Medical Center, Durham, NC.
AJR Am J Roentgenol. 2015 Jul;205(1):203-8. doi: 10.2214/AJR.14.13354.
The purpose of this study was to assess the contribution of ultrasound to the evaluation of patients with pathologic nipple discharge.
A retrospective review was conducted of the records of females who presented with nipple discharge between January 1, 2009, and December 31, 2011. Pathologic nipple discharge was defined as discharge with one or more of the following features: unilateral, clear or bloody, and spontaneous. Patients underwent bilateral mammography followed by ultrasound directed at the subareolar portion of the affected breast. Radiologic findings and pathologic results were reviewed.
Over a 3-year period, 327 females (mean age, 48 years; range, 13-88 years) presented with nipple discharge. Among these patients, 273 (83%) underwent surgical excision or clinical or radiographic follow-up at least 2 years after presentation and composed the study population. Among the 273 patients, 262 (96%) underwent mammography and 246 (90%) underwent sonography. Among 252 patients who had at least one pathologic feature of nipple discharge and underwent surgical excision or at least 2 years of follow-up, a total of 20 (8%) cases of ductal carcinoma in situ (DCIS) or invasive adenocarcinoma were diagnosed. DCIS or invasive adenocarcinoma was diagnosed in eight patients with normal sonographic findings. For the detection of DCIS and invasive adenocarcinoma, the sensitivity and specificity of ultrasound were 56% (10/18) and 75% (170/228); the sensitivity and specificity of mammography were 15% (3/20) and 98% (237/242).
For females presenting with pathologic nipple discharge, ultrasound is a useful diagnostic tool and may be worth including in the routine evaluation.
本研究旨在评估超声对病理性乳头溢液患者评估的贡献。
对2009年1月1日至2011年12月31日期间出现乳头溢液的女性患者记录进行回顾性分析。病理性乳头溢液定义为具有以下一种或多种特征的溢液：单侧、清亮或血性、自发性。患者接受双侧乳腺钼靶检查，随后对患侧乳房乳晕下部分进行超声检查。回顾放射学检查结果和病理结果。
在3年期间，327名女性（平均年龄48岁；范围13 - 88岁）出现乳头溢液。在这些患者中，273名（83%）在就诊后至少2年接受了手术切除或临床或影像学随访，构成研究人群。在这273名患者中，262名（96%）接受了乳腺钼靶检查，246名（90%）接受了超声检查。在252名具有至少一项乳头溢液病理特征并接受手术切除或至少2年随访的患者中，共诊断出20例（8%）导管原位癌（DCIS）或浸润性腺癌。8名超声检查结果正常的患者被诊断为DCIS或浸润性腺癌。对于DCIS和浸润性腺癌的检测，超声的敏感性和特异性分别为56%（10/18）和75%（170/228）；乳腺钼靶的敏感性和特异性分别为15%（3/20）和98%（237/242）。
对于出现病理性乳头溢液的女性，超声是一种有用的诊断工具，可能值得纳入常规评估。
