Filipe Mando Dyko, Waaijer Laurien, van der Pol Carmen, van Diest Paul Joannes, Witkamp Arjen Joost
Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands.
Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands.
Clin Breast Cancer. 2020 Jun;20(3):e334-e343. doi: 10.1016/j.clbc.2019.12.008. Epub 2020 Jan 27.
Pathologic nipple discharge (PND) is, after palpable lumps and pain, the most common breast-related reason for referral to the breast surgeon and is associated with breast cancer. However, with negative mammography and ultrasound, the chance of PND being caused by malignancy is between 5% and 8%. Nevertheless, most patients with PND still undergo surgery in order to rule out malignancy. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization. The aim of this study was to evaluate (interventional) ductoscopy as an alternative to surgery in patients with negative conventional imaging.
All patients with PND referred between 2010 and 2017 to our hospital for ductoscopy were retrospectively analyzed. Ductoscopy procedures were performed under local anesthesia in the outpatient clinic. The follow-up period was at least 3 months, and the primary outcome was the number of prevented surgical procedures. Furthermore, we evaluated possible complications after ductoscopy (infection and pain).
A total of 215 consecutive patients undergoing ductoscopy were analyzed. In 151 (70.2%) patients, ductoscopy was successful. In 102 procedures, an underlying cause for PND was visualized, of which 34 patients could be histologically proven and 82 patients treated. Sixty of the 215 patients were eventually operated, 8 owing to suspicious findings during ductoscopy, 42 owing to persistent PND, and 10 because of recurrent PND. In 7 patients, a malignancy was found (5 of them classified as suspicious at dusctoscopy). No serious side effects were seen.
Ductoscopy can be safely used as an alternative for surgery in the workup for PND.
病理性乳头溢液（PND）是继可触及肿块和疼痛之后，转诊至乳腺外科最常见的乳腺相关原因，且与乳腺癌相关。然而，在乳腺X线摄影和超声检查结果为阴性的情况下，PND由恶性肿瘤引起的几率在5%至8%之间。尽管如此，大多数PND患者仍接受手术以排除恶性肿瘤。导管镜检查是一种微创内镜技术，可实现导管内直接可视化。本研究的目的是评估（介入性）导管镜检查作为传统影像学检查阴性患者手术替代方法的效果。
回顾性分析2010年至2017年间转诊至我院进行导管镜检查的所有PND患者。导管镜检查在门诊局部麻醉下进行。随访期至少3个月，主要结局是避免手术的患者数量。此外，我们评估了导管镜检查后可能出现的并发症（感染和疼痛）。
共分析了215例连续接受导管镜检查的患者。151例（70.2%）患者导管镜检查成功。在102例检查中，发现了PND的潜在病因，其中34例经组织学证实，82例接受了治疗。215例患者中有60例最终接受了手术，8例是因为导管镜检查期间发现可疑结果，42例是因为持续性PND，10例是因为复发性PND。7例患者发现了恶性肿瘤（其中5例在导管镜检查时被分类为可疑）。未观察到严重副作用。
导管镜检查可安全地用作PND检查中手术的替代方法。
