【Abstract】Objective To evaluate the application of duct endoscopy in the diagnosis of breast diseases characterized by nipple discharge. Methods One hundred and sixtynine consecutive cases from October 2003 to September 2004 who had duct endoscopy for nipple discharge were reviewed and followed up. Results Of 169 cases, 79 ductitis, 62 intraductal papilloma, 9 intraductal carcinoma in situ, 19 without breast diseases were diagnosed under duct endoscopy. During following up, the diagnostic accuracy of intraductal papilloma and intraductal carcinoma in situ with duct endoscopy was 89.8%(44/49) and 55.6%(5/9),respectively. There was only one patient who had breast pain and mild skin redness which was cured with oral antibiotics for 3 days. Conclusion Duct endoscopy is an only technique to explore the etiology for duct discharge under vision. It is direct, safe and effective, with a high accuracy.
ObjectiveTo introduce the current status of clinical application, value and perspective of fiberoptic ductoscopy.MethodsThe related literatures on advances in clinical application of fiberoptic ductoscopy were reviewed.ResultsFiberoptic ductoscopy is now widely used in breast diseases, especially complicated with nipple discharge, and it has a higher accuracy rate than routine examinations. With ductoscopy, ductal lavage,location, biopsy and treatment can be carried out.ConclusionFiberoptic ductoscopy has a greater value in diagnosis and treatment, we believe it will be better applied and further developed.
目的 探讨纤维乳管镜（FDS）联合液基薄层细胞学检查（TCT）在诊断非血性乳头溢液中的临床价值。方法 回顾性分析笔者所在医院2008年7月至2011年7月期间因非血性单侧单孔乳头溢液的176例住院患者的临床资料。所有患者均行FDS检查及冲洗液TCT，且均有明确的病理学诊断结果，比较联合法与单一FDS或TCT检查的诊断准确率。结果 FDS的诊断准确率为80.7%（142/176），TCT为53.4%（94/176），联合法为86.9% （153/176）。结论 FDS联合TCT对非血性乳头溢液的诊断准确率高，可以提高FDS检查阴性的乳腺疾病的检出率。
目的 探讨乳腺导管扩张症的临床特点、诊断、鉴别诊断及治疗。方法 对我院1990年至1999年收治的30例乳腺导管扩张症患者，进行一般情况、治疗及预后的回顾性分析和总结。结果 本组病例平均发病年龄42岁，首发症状以乳腺肿块和乳头溢液多见，病变多位于乳晕周围，所有患者均行手术治疗。结论 乳腺导管扩张症为非感染性炎症，病史长、易反复，鉴别诊断有一定困难，均需外科治疗。
Objective To detect the features of breast carcinoma with nipple discharge using selective galactography and evaluate the value of this method. Methods The galactography findings of 39 cases of pathology proved breast carcinoma with nipple discharge were analyzed retrospectively. Results Among the 39 cases, the pathology diagnosis included 7 cases of intraductal papillary carcinoma, 13 cases of ductal carcinoma in situ, and 19 cases of invasive ductal carcinoma. The galactographic features included: duct filling defect (24 cases, 61.5%), ductal obstruction (15 cases, 38.5%), rigidity and disorder (31 cases, 79.5%), wormy erosion sign (18 cases, 46.2%), pond lake sign (4 cases, 10.3%), ductal interruption (17 cases, 43.6%), ductal stenosis (24 casesm, 61.5%), ductal dilatation (22 cases, 56.4%). Among all of the cases, the accuracy rate of mammography and galactography was 64.1% (25/39) and 87.2% (34/39), respectively (P＜0.05). Among the 13 cases of ductal carcinoma in situ, the accuracy rate of mammography and galactography was 61.5% (8/13) and 100% (13/13), respectively (P＜0.05). Conclusion Selective galactography could improve the detection rate of breast carcinoma, and has great value in the early diagnosis of ductal carcinoma in situ.
Objective To investigate feasibility and preliminary oncological safety of surgical innovations in breast cancer patients who have undergone nipple-skin-sparing mastectomy (NSSM) for nipple discharge or central lesions and tumors that do not involve the nipple-areola skin. MethodsBetween May 2018 and November 2023, patients diagnosed with breast cancer presenting nipple discharge or lesions in the central area underwent NSSM. The imaging assessment revealed no involvement of the nipple-areola-skin by the tumor. We performed a surgical removal of the affected mammary duct and simultaneously made a circular incision measuring 3-4 mm in diameter at the apex of the nipple. The study also involved the collection of clinical data, early complications, oncological outcomes and conducting aesthetic analysis of the nipple using the BREAST-Q scale. Results The surgical procedure was conducted on a cohort of 39 female patients at age of 27-57(39.0±7.6) years. The postoperative pathological stages of breast cancer were distributed as follows: stage 0 in 2 patients (5.1%), stageⅠ in 1 patients (2.6%), ⅡA stage in 15 patients (38.5%), ⅡB stage in 21 patients (53.8%). Tumor type: simple carcinoma in situ in 5 patients (12.8%), invasive carcinoma in 14 patients (35.9%), including invasive carcinoma with carcinoma in situ in 20 patients (51.3%). During the median follow-up period of 15.0 (2-66) months, 3 patients (7.7%) developed decolorization caused by mild nipple ischemia; there was no nipple necrosis; 1 patient (2.6%) failed nipple reconstruction (no milk column, the milk column disappeared due to external dressing compression after operation). There were no incision complications, subcutaneous emphysema or intramammary hematoma in all patients. Two patients (5.1%) underwent prosthesis removal and nipple areola excess skin resection because of prosthesis cavity infection and final exposure caused by debridement, dressing change, redrainage and so on. As of April 2024, no tumor recurrence or metastasis was found during the follow-up period. The satisfaction of patients with nipple was 97.4% according to BREAST-Q score. ConclusionThe satisfaction of breast cancer patients diagnosed with nipple discharge or lesions in the central area, but without involvement of the nipple areola skin, and who underwent subcutaneous mastectomy with immediate reconstruction is significantly enhanced. Furthermore, there is no increased risk of tumor recurrence or metastasis in short-term.