Ambrogetti D, Berni D, Catarzi S, Ciatto S
Centro per lo Studio e la Prevenzione Oncologica, Firenze.
Radiol Med. 1996 Mar;91(3):198-201.
The authors report on a series of 1009 consecutive patients submitted to clinical examination, mammography, cytology and galactography for the presence of nipple discharge. Galactography was performed mainly in the presence of hematic nipple discharge. Surgical biopsy was performed in 392 cases, and 52 cancers (31 invasive and 21 intraductal lesions) were diagnosed, which were suspected at palpation, mammography, cytology and galactography in 17, 17, 18 and 31 cases, respectively. Forty of 52 cancers were suspected on the basis of combined exam findings, while 8 cancers (7 intraductal and 1 invasive lesions) were submitted to biopsy on the basis of a galactographic diagnosis of multiple benign papilloma, an (invasive) lesion with a diagnosis of single papilloma, and 3 (invasive) lesions because of persistent hematic discharge. Cancer was suspected with only one exam in 14 cases: 3 at cytology, 2 at mammography, 1 at clinical examination and 8 at galactography. Hematic discharge alone is not a sufficient reason to indicate surgery, because its positive predictive value for cancer is low (< or = 10%), while cytology is of limited help because of its poor sensitivity (34.6%). In contrast, galactography (59.6% sensitivity) gives a greater contribution to differential diagnosis and is always indicated in the presence of hematic discharge. Galactographic evidence suspicious for cancer (67.3% positive predictive value) or for multiple papilloma (9.7% positive predictive value) is sufficient to advise open biopsy. The surgical removal of single papillomas is of questionable benefit, since single papillomas are benign lesions, with no clear evidence of progression to cancer. In our series, only one cancer was misdiagnosed as a single papilloma at galactography (0.5% positive predictive value).
作者报告了连续1009例因乳头溢液接受临床检查、乳房X线摄影、细胞学检查和乳管造影的患者。乳管造影主要在血性乳头溢液的情况下进行。392例患者接受了手术活检，诊断出52例癌症（31例浸润性病变和21例导管内病变），在触诊、乳房X线摄影、细胞学检查和乳管造影中分别有17例、17例、18例和31例怀疑为癌症。52例癌症中有40例是根据综合检查结果怀疑的，而8例癌症（7例导管内病变和1例浸润性病变）是基于乳管造影诊断为多发性良性乳头状瘤、诊断为单个乳头状瘤的（浸润性）病变以及3例（浸润性）病变因持续性血性溢液而接受活检的。仅通过一项检查怀疑为癌症的有14例：细胞学检查3例、乳房X线摄影2例、临床检查1例、乳管造影8例。仅血性溢液不足以作为手术指征，因为其对癌症的阳性预测值较低（≤10%），而细胞学检查由于敏感性较差（34.6%）帮助有限。相比之下，乳管造影（敏感性为59.6%）对鉴别诊断的贡献更大，在血性溢液的情况下总是需要进行。乳管造影显示可疑癌症（阳性预测值为67.3%）或多发性乳头状瘤（阳性预测值为9.7%）的证据足以建议进行开放性活检。单个乳头状瘤的手术切除益处存疑，因为单个乳头状瘤是良性病变，没有明确的进展为癌症的证据。在我们的系列研究中，乳管造影仅将1例癌症误诊为单个乳头状瘤（阳性预测值为0.5%）。
