Alshurbasi Nour, Cartlidge Christopher W J, Kohlhardt Stanley R, Hadad Sirwan M
Department of Breast and Plastic Surgery, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, United Kingdom.
Breast Care (Basel). 2020 Oct;15(5):491-497. doi: 10.1159/000504528. Epub 2019 Dec 13.
The unexpected diagnosis of breast cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, pre-operative diagnosis of malignancy still evades us. The aim of this study was to review the pathological findings of total duct excision and microdochectomy with reference to pre-operative symptoms, ultrasound, or mammographic findings and identify features associated with increased likelihood of malignant disease.
Data were collected retrospectively of all patients who underwent total duct excision surgery in a single centre (2011-2017). Pre-operative demographics, symptoms, and imaging findings were recorded and correlated with subsequent pathology.
214 patients underwent total duct excision; data were available for 211. Median age was 53 years. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10%) had "risk" lesions (papilloma with atypia, atypical ductal hyperplasia), and 15/211 (7.1%) had malignancy (ductal carcinoma in situ). Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1). 71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7%) had "risk" lesions, and 6/71 (8.5%) had malignant lesions. 83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk, and 10/83 (12%) malignancy. 38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk, and 2/38 (5.3%) malignant lesions.
Neither imaging nor presenting symptoms correlate with the likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.
在进行全乳管切除术之后意外诊断出乳腺癌，这让患者感到痛苦。尽管放射学取得了进展，且对可疑乳头溢液也有了描述，但术前对恶性肿瘤的诊断仍然难以实现。本研究的目的是参照术前症状、超声或乳腺X线摄影检查结果，回顾全乳管切除术和微小乳管切除术的病理结果，并确定与恶性疾病可能性增加相关的特征。
回顾性收集了在单一中心接受全乳管切除手术的所有患者（2011 - 2017年）的数据。记录术前人口统计学资料、症状和影像学检查结果，并与后续病理结果进行关联分析。
214例患者接受了全乳管切除术；211例患者的数据可用。中位年龄为53岁。在最终组织学检查中，175/211（82.9%）的患者有良性病理结果（导管扩张、无异型性的乳头状瘤、纤维囊性变），21/211（10%）有“风险”病变（有异型性的乳头状瘤、非典型导管增生），15/211（7.1%）有恶性肿瘤（导管原位癌）。在15例有恶性病变的患者中，6/15（40%）的影像学检查结果正常（M1，U1）。71/211（33.6%）的影像学检查结果正常（M1，U1）：60/71（84.5%）有良性疾病，5/71（7%）有“风险”病变，6/71（8.5%）有恶性病变。83/211（39.3%）的患者出现血性溢液：64/83（77.1%）有良性病理结果，9/83（10.8%）有风险，10/83（12%）有恶性肿瘤。38/211（18%）的患者出现非血性溢液：32/38（84.2%）有良性疾病，4/38（10.5%）有风险，2/38（5.3%）有恶性病变。
影像学检查结果和出现的症状均与最终病理检查中存在恶性疾病的可能性无关。即使术前诊断取得了进展，全乳管切除术仍然是一项重要的诊断和治疗手段。
