目的

探讨乳管镜(FDS)检查中冲洗液薄层液基细胞学(TCT)检查辅助诊断乳头溢液病因的价值。

方法

对2004年4月至2006年6月间107 例乳头溢液患者进行FDS 和冲洗液TCT 检查,79 例接受手术活检和治疗,将各种检查与病理检查结果进行对照研究。

结果

FDS 下确定30 例乳头溢液患者,乳管内隆起型病变的占77 例,位于三级以下乳管占88.3%。FDS 和TCT 检查总符合率为74.7%和81.0%,病变在二级导管以上FDS 和TCT 检查符合率为86.7%和76.7%,三级以下导管,两种检查符合为67.3%和83.7%;FDS 和TCT 检查诊断多发乳头状瘤符合率、阳性试验似然比(likelihood ratio of a positive test,LR)分别为60.3%、3.67 和84.2%、4.46;FDS 和TCT 检查诊断乳腺癌符合率、LR 分别为66.7%、1.46和100%、6.84。TCT 或FDS 联合后对恶性病变诊断阳性试验似然比(LR)可达25.5。

结论

二级以上乳管病变FDS 检查准确性高,三级以下辅助乳管冲洗液TCT 检查,提高乳头溢液诊断准确性。对于FDS 诊断疑难的病例两者联合有助于提高良恶性病变的鉴别诊断。

Objective

To evaluate the value of intraductal aspiration ThinPrep Cytology Test (TCT) by fiberoptic ductoscopy (FDS) in the diagosis of nipple discharge.

Methods

FDS,intraductal aspiration TCT by FDS were used to diagnose and examine 107 patients with confused nipple discharge during April 2004 to June 2006; 79 patients were treated operatively. The results of diagnosis and biopsy pathology were studied.

Results

Using FDS 107 patients with nipple discharge were diagnosed. 77 were detected to have intraductal tumor, and 88.3% was below the third branch duct. The over accuracy of FDS and TCT was 74.7% and 81.0%. The accuracy of FDS and TCT was 86.7% and 76.7% over the second branch duct. But the first branch duct and the second branch duct accounted for 67.3% and 83.7%. The accuracy, sensitivity and specificity were 60.3%, 81.4% and 77.8% for intraductal papillomas, and those of TCT were 84.2%,7 4.4% and 83.3% , respectively.And their Likelihood ratio of a positive test (LR) was 3.67 and 4.46, that of FDS for breast cancer was 66.7%,31.6% and 78.3%, and that of TCT was 100%, 68.4% and 90%, respectively. FDS and TCT were used together to diagnose breast cancer , and the sensitivity and specificity were improved to 84.2% and 96.7%. And their LR was 1.46 and 6.84, LR of combined use of the two means to diagnose breast cancer reached 25.5.

Conclusions

FDS is a good method to diagnose nipple discharge of the first branch and the second branch. But for the third branch, combine use of FDS with TCT can improve the accuracy and decrease false-negative rate of nipple discharge. It is helpful in differentiating malgnant from benign discharge.