Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Br J Surg. 2015 Dec;102(13):1639-48. doi: 10.1002/bjs.9950. Epub 2015 Oct 8.
Surgery is the intervention of choice for definitive diagnosis and treatment in women with pathological nipple discharge (PND). Ductoscopy has been reported to improve diagnosis, but as an interventional procedure it may also reduce the need for surgery. This study evaluated interventional ductoscopy in patients with PND.
A prospective study on ductoscopy was conducted in consecutive patients with PND, but without a suspected malignancy on routine diagnostic evaluation. Intraductal lesions were removed by ductoscopic extraction. Surgery was undertaken if there were suspicious ductoscopic findings or at the patient's request. Therapeutic efficacy was determined by cannulation success, detection and removal rates, symptom resolution and avoided surgery.
Ductoscope introduction was successful in 71 (87 per cent) of 82 patients, with abnormalities visualized in 53 (65 per cent); these were mostly polypoid lesions (29 patients). The lesion was removed in 27 of 34 attempted ductoscopic extractions. Twenty-six (32 per cent) of the 82 patients underwent surgery, whereas surgery was avoided in 56 (68 per cent). After a median follow-up of 17 (range 3-45) months, 40 patients (49 per cent) no longer experienced symptoms of PND, 13 of 34 patients experienced an insufficient therapeutic effect after attempted ductoscopic extraction, and the outcome was unknown in two (2 per cent). Malignancy was diagnosed in four patients (5 per cent); two had been missed at ductoscopy and two at initial surgery after ductoscopy.
Interventional ductoscopy is technically feasible and may help to avoid surgery in the majority of patients. As endoscopic removal of intraductal lesions is not always possible and malignancy can be the underlying cause of PND, ductoscopic instruments should be further optimized to allow definitive histological diagnosis.
对于病理性乳头溢液（PND）患者，手术是明确诊断和治疗的首选方法。有报道称，乳管镜检查可提高诊断率，但作为一种介入性操作，它也可能减少手术的需要。本研究评估了 PND 患者的介入性乳管镜检查。
对连续的 PND 患者进行前瞻性乳管镜检查研究，但在常规诊断评估中没有可疑恶性肿瘤。通过乳管镜切除管内病变。如果有可疑的乳管镜发现或患者要求，行手术治疗。通过导管插入成功率、检出和切除率、症状缓解和避免手术来确定治疗效果。
82 例患者中有 71 例（87%）成功插入乳管镜，53 例（65%）可见异常；这些病变大多为息肉样病变（29 例）。在 34 次尝试的乳管镜下切除中，有 27 次成功切除病变。82 例患者中有 26 例（32%）行手术治疗，56 例（68%）避免了手术。中位随访 17 个月（范围 3-45 个月）后，40 例（49%）患者不再出现 PND 症状，34 例中有 13 例患者尝试乳管镜下切除后疗效不佳，2 例（2%）患者结局未知。4 例（5%）患者诊断为恶性肿瘤；其中 2 例在乳管镜下漏诊，2 例在乳管镜下手术后漏诊。
介入性乳管镜检查在技术上是可行的，可以帮助大多数患者避免手术。由于管内病变的内镜切除并非总是可行，且恶性肿瘤可能是 PND 的潜在原因，因此需要进一步优化乳管镜器械以获得明确的组织学诊断。
