探讨纤维乳管镜与乳腺超声在伴有乳头溢液的乳管内占位性病变中的诊断价值。

回顾性分析重庆医科大学附属第一医院内分泌乳腺外科2017年1月至2018年2月收治的133例乳头溢液患者临床资料，分析纤维乳管镜与乳腺超声检查在乳头溢液患者乳管内占位性病变诊断中的应用情况。采用配对χ²检验比较2种检查间乳管内占位性病变检出率的差异，以及纤维乳管镜与乳腺超声诊断乳管内乳头状瘤敏感度的差异，并用Fisher确切概率法比较亚组间乳管内占位性病变为恶性肿瘤的概率。

133例患者中，有63例患者行溢液乳管腺段切除术，4例行乳腺结节微创旋切术，穿刺或包块切除术明确为恶性肿瘤后行根治术各1例，53例患者未行手术，11例患者失访。65例常规手术患者(非微创旋切术)术后病理结果：乳腺恶性肿瘤4例，乳管内乳头状瘤57例，乳腺增生4例。纤维乳管镜检查对乳管内占位性病变的检出率为57.1% (76/133)，高于乳腺超声检查的24.8% (33/133)(χ²＝31.339，P<0.001)，且纤维乳管镜诊断乳管内乳头状瘤的敏感度优于乳腺超声检查[93.0%(53/57)比42.1%(24/57)，χ²＝33.652，P<0.001)。纤维乳管镜提示乳管内占位性病变的患者中，乳管内占位性病变出血或合并乳房包块者与未出血且无乳房包块者相比，发生恶性肿瘤的概率更高[3/13比2.3%(1/44)，P＝0.034]。

纤维乳管镜对乳管内占位性病变的诊断具有优势，可以作为乳头溢液患者的常规检查。对于乳管内占位性病变合并乳房包块或者瘤体出血的患者，应行手术切除以明确诊断。

To explore the diagnostic value of mammary ductoscopy and breast ultrasonography in intraductal space-occupying lesions with nipple discharge.

The clinical data of 133 patients with nipple discharge in the Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University from January 2017 to February 2018 were retrospectively analyzed. The application of mammary ductoscopy and breast ultrasonography was analyzed for the diagnosis of intraductal space-occupying lesions in nipple discharge patients. Paired χ² test was used to compare the detection rates of intraductal space-occupying lesions between two methods and analyze the sensitivity of mammary ductoscopy and breast ultrasonography in the diagnosis of intraductal papilloma. Fisher exact probability test were used to compare the malignancy rate of intraductal space-occupying lesions between two groups.

In 133 patients, 63 patients underwent duct excision, 4 minimal invasive surgery of breast nodes, 2 radical mastectomy after the malignancy was confirmed (one case by core-needle biopsy and the other by lumpectomy). Fifty-three patients underwent no surgery and 11 patients were lost to follow-up. In 65 patients receiving conventional surgery, postoperative pathology revealed malignant breast tumor in 4 patients, intraductal papilloma in 57 and breast hyperplasia in 4. The detection rate of intraductal space-occupying lesions by mammary ductoscopy was 57.1% (76/133), significantly higher in 24.8% (33/133) by breast ultrasonography (χ²=31.339, P<0.001). The sensitivity of mammary ductoscopy was significantly higher than that of breast ultrasonography in the diagnosis of intraductal papilloma [93.0%(53/57) vs 42.1%(24/57), χ²=33.652, P<0.001). Among the patients with intraductal space-occupying lesions indicated by mammary ductoscopy, the patients with breast mass or bleeding of space-occupying lesions had a significantly higher incidence of malignancy compared with the patients without breast mass or bleeding [3/13 vs 2.3% (1/44), P=0.034].

Mammary ductoscopy is superior in the diagnosis of intraductal space-occupying lesions and can be used as a routine examination for patients with nipple discharge. For patients with intraductal space-occupying lesions associated with breast mass or tumor hemorrhage, surgical resection should be performed to confirm the diagnosis.