Zhang Fengfeng, Wang Silei, Liu Bin, Yang Wenshi
Department of Breast and Thyroid Surgery, the Central People's Hospital of Tengzhou, Tengzhou, China;, 277500, China.
BMC Cancer. 2025 Jan 10;25(1):60. doi: 10.1186/s12885-025-13467-8.
Pathological nipple discharge (PND) is associated with malignancy. This study aimed to investigate the value of fiberoptic ductoscopy (FDS) and the feasibility of immediate injection of methylene blue after FDS to identify discharging ducts and intraductal lesions without overflow of methylene blue during surgery.
From May 2019 to December 2023, 164 PND patients were enrolled. Methylene blue was injected into the discharging ducts immediately after FDS. Surgery was underwent several hours later. The dyeing effect and the operation time were assessed. The pathological results were analyzed with clinical characteristics and ductoscopic appearances.
The overall detection rate of malignancy was 14.0% (23/164). Both ultrasound (US) and mammography (MG) were negative in 80 (48.8%) patients, while pathology yielded 10 (12.5%) breast cancers. Statistical analysis revealed that patients exhibiting older age, menopause, positive MG, and bloody discharge had a higher propensity for malignancy (P < 0.05). Ductoscopic features such as multiple and distal lesions, irregular morphology and hemorrhage of the lesions, and roughness and stiffness of the ductal walls were associated with malignancy (P < 0.05). Conducting surgery 12-24 h after injection of methylene blue resulted in optimal dyeing without overflow of methylene blue.
FDS is an effective and feasible examination for PND patients with negative imaging results. Immediate injection of methylene blue after FDS allows clear identification of discharging ducts and intraductal lesions without overflow of methylene blue. This approach may be useful in guiding selective ductectomy for the detection of early breast cancer.
病理性乳头溢液（PND）与恶性肿瘤相关。本研究旨在探讨纤维乳管镜（FDS）的价值以及FDS后立即注射亚甲蓝以识别溢液乳管和导管内病变且术中无亚甲蓝外溢的可行性。
2019年5月至2023年12月，纳入164例PND患者。FDS后立即将亚甲蓝注入溢液乳管。数小时后进行手术。评估染色效果和手术时间。分析病理结果与临床特征及乳管镜表现。
恶性肿瘤的总体检出率为14.0%（23/164）。80例（48.8%）患者的超声（US）和乳腺钼靶（MG）检查均为阴性，而病理检查发现10例（12.5%）乳腺癌。统计分析显示，年龄较大、绝经、MG阳性和血性溢液的患者发生恶性肿瘤的倾向较高（P＜0.05）。乳管镜特征如多发及远端病变、病变形态不规则和出血以及管壁粗糙和僵硬与恶性肿瘤相关（P＜0.05）。在注射亚甲蓝后12 - 24小时进行手术可获得最佳染色效果且无亚甲蓝外溢。
对于影像检查结果为阴性的PND患者，FDS是一种有效且可行的检查方法。FDS后立即注射亚甲蓝可清晰识别溢液乳管和导管内病变且无亚甲蓝外溢。该方法可能有助于指导选择性乳管切除术以检测早期乳腺癌。
