Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands.
Department of Pathology, University Medical Center, Utrecht, The Netherlands.
BJS Open. 2023 Jul 10;7(4). doi: 10.1093/bjsopen/zrad066.
The role of duct excision surgery is not clearly defined in patients with pathological nipple discharge without other clinical and radiological abnormalities. The primary aim of this systematic review was to determine the malignancy rate in patients with pathological nipple discharge after duct excision surgery (microdochectomy/major duct excision). The secondary aims were to determine the recurrence rate of pathological nipple discharge after surgery and to assess breast cancer development after surgery.
MEDLINE and Embase were searched from inception to March 2023, using search terms related to 'nipple discharge', 'nipple fluid', 'microdochectomy', 'duct excision', and 'minimally invasive surgical procedure'. Studies reporting data about women who underwent duct excision surgery for pathological nipple discharge without clinical and radiological suspicion of breast cancer, as well as reporting data on women diagnosed with breast cancer after duct excision surgery, were included.
A total of 318 titles were identified, of which nine publications were included in the analysis. This resulted in 1108 patients with pathological nipple discharge who underwent a duct excision. The weighted mean rate of malignancy after duct excision surgery was 8.1 per cent (ranging from 2.3 to 13.5 per cent). Three studies described the recurrence rate of pathological nipple discharge (ranging from 0 to 12 per cent) and two studies reported breast cancer development in the follow-up in a total of three patients (less than 1 per cent).
The malignancy rate after duct excision surgery for pathological nipple discharge was low in patients with pathological nipple discharge without radiological and clinical abnormalities and approximately 9 of 10 patients undergo surgery for a benign cause. Improvement of the diagnostic and therapeutic workup is needed to prevent patients from undergoing (unnecessary) exploratory surgery.
在没有其他临床和影像学异常的病理性乳头溢液患者中，切除导管手术的作用尚未明确界定。本系统评价的主要目的是确定接受导管切除术（微切开术/主要导管切除术）后的病理性乳头溢液患者的恶性肿瘤发生率。次要目的是确定手术后病理性乳头溢液的复发率，并评估手术后乳腺癌的发展情况。
从建库至 2023 年 3 月，使用与“乳头溢液”、“乳头分泌物”、“微切开术”、“导管切除术”和“微创外科手术”相关的检索词，在 MEDLINE 和 Embase 中进行检索。纳入的研究报告了为病理性乳头溢液而接受导管切除术的女性患者的数据，这些患者无乳腺癌的临床和影像学怀疑，并且报告了接受导管切除术的女性患者诊断为乳腺癌的数据。
共确定了 318 个标题，其中 9 篇出版物纳入分析。这包括 1108 例接受导管切除术的病理性乳头溢液患者。导管切除术后恶性肿瘤的加权平均发生率为 8.1%（范围为 2.3%至 13.5%）。有 3 项研究描述了病理性乳头溢液的复发率（范围为 0%至 12%），有 2 项研究报告了在总共 3 例患者的随访中发现乳腺癌（小于 1%）。
在无影像学和临床异常的病理性乳头溢液患者中，导管切除术后的恶性肿瘤发生率较低，约 10 例患者中有 9 例接受手术是良性原因。需要改进诊断和治疗工作流程，以防止患者接受（不必要的）探查性手术。
