Department of Thyroid and Breast Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China.
Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China.
Medicine (Baltimore). 2023 Aug 11;102(32):e34589. doi: 10.1097/MD.0000000000034589.
The etiology of nipple discharge is often unclear, and there are few studies exploring diagnostic approaches of nipple discharge. Galactography is a common method for clinical diagnosis of patients with nipple discharge. Therefore, this study aimed to evaluate the use of galactography in differentiating between benign and malignant lesions in patients with nipple discharge. A retrospective study of 161 patients with nipple discharges, who were evaluated with galactography and underwent surgery in Qilu Hospital of Shangdong University between January 2018 and December 2019, was conducted. Baseline characteristics were obtained from their electronic records including age, menstruation status, physical examination, galactography, cytology, and pathology. There were 110 cases of benign disease, 12 cases of high-risk disease, and 39 cases of malignant disease. With respect to benign diseases there were 26 (23.6%) patients with hyperplasia and ductal ectasia, and 94 (76.4%) with intraductal papilloma. With respect to high risk diseases, there were 2 (16.7%) patients with atypical intraductal papilloma and 10 (83.4%) with atypical hyperplasia. With respect to malignant lesions, 19 (48.7%) patients had intraductal carcinoma, 4 (10.3%) had solid papillary carcinoma, and 16 (41.0%) had invasive carcinoma. The significant findings of our study are as follows: patients with malignant diseases had a higher proportion of concomitant masses (74.4% vs 41.7% vs 22.7%, P < .001), positive spill cytology (51.3% vs 41.7% vs 2.7%, P < .001), and trunk signs (71.8% vs 33.3% vs 10.9%, P < .001). A forest plot revealed that trunk signs were related to an increased risk of malignant diseases in almost all the subgroups. Galactography is important for the differential diagnosis of benign and malignant lesions in nipple discharge, and the "Trunk sign" is an important radiographic sign of malignant lesions. Combining galactography with other methods is advisable to improve the accuracy of diagnosis in patients with nipple discharge.
乳头溢液的病因通常不明确，并且很少有研究探索乳头溢液的诊断方法。乳管造影术是临床诊断乳头溢液患者的常用方法。因此，本研究旨在评估乳管造影术在区分乳头溢液患者良性和恶性病变中的作用。本研究回顾性分析了 2018 年 1 月至 2019 年 12 月在山东大学齐鲁医院接受乳管造影术和手术的 161 例乳头溢液患者的资料。从电子病历中获取患者的基本特征，包括年龄、月经状态、体格检查、乳管造影、细胞学和病理学。其中良性疾病 110 例，高危疾病 12 例，恶性疾病 39 例。良性疾病中，乳腺增生伴导管扩张 26 例（23.6%），导管内乳头状瘤 94 例（76.4%）。高危疾病中，非典型导管内乳头状瘤 2 例（16.7%），非典型增生 10 例（83.4%）。恶性病变中，导管内癌 19 例（48.7%），实体性乳头状癌 4 例（10.3%），浸润性癌 16 例（41.0%）。本研究的重要发现如下：恶性疾病患者中伴有肿块的比例更高（74.4% vs. 41.7% vs. 22.7%，P <.001），溢液细胞学阳性的比例更高（51.3% vs. 41.7% vs. 2.7%，P <.001），乳管铸型征阳性的比例更高（71.8% vs. 33.3% vs. 10.9%，P <.001）。森林图显示，乳管铸型征在几乎所有亚组中均与恶性疾病的风险增加相关。乳管造影术对区分乳头溢液的良性和恶性病变具有重要意义，“铸型征”是恶性病变的重要影像学征象。建议将乳管造影术与其他方法相结合，以提高乳头溢液患者的诊断准确性。
