Arnold G J, Neiheisel M B
College of Nursing, University of Southwestern Louisiana, Lafayette, USA.
Nurse Pract. 1997 Jul;22(7):96-102, 105-11.
While emphasis is justifiably placed on the importance of detecting breast masses during breast examination, the equally important need for accurate assessment of nipple discharge is often overlooked. Inspection and palpation for nipple discharge should be part of every breast examination. When detected, a critical analysis should be made of every nipple discharge, with the ultimate objective being differentiation between benign and malignant discharges. All nipple discharges can be defined by the physical characteristics of laterality, spontaneity, color, consistency, number of ducts involved, and duration. By correlating these characteristics with certain historical features (e.g., age, pregnancy, trauma, drugs), accurate determination of etiology can be made. A four-step approach is presented that offers a logical method for making the essential correlations. The sequence of the four relevant questions proposed gives the examiner a logical basis from which to assign clinical importance to each discharge. An algorithm is outlined that correlates diagnostic considerations with therapeutic actions.
虽然在乳房检查中强调检测乳房肿块的重要性是合理的，但对乳头溢液进行准确评估这一同样重要的需求却常常被忽视。对乳头溢液进行视诊和触诊应成为每次乳房检查的一部分。一旦发现乳头溢液，应对每一例溢液进行批判性分析，最终目的是区分良性和恶性溢液。所有乳头溢液都可根据单侧性、自发性、颜色、质地、受累导管数量和持续时间等物理特征来定义。通过将这些特征与某些病史特征（如年龄、妊娠、外伤、药物）相关联，可准确确定病因。本文提出了一种四步法，为进行必要的关联提供了一种合乎逻辑的方法。所提出的四个相关问题的顺序为检查者提供了一个逻辑基础，据此可赋予每次溢液临床重要性。文中概述了一种将诊断考虑因素与治疗行动相关联的算法。
