纤维乳腺导管镜在乳头溢液中的诊断价值
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摘要
目的探讨纤维乳腺导管镜(fiber ductoscopy,FDS)在乳头溢液疾病诊断中的应用价值。方法选取2016-07至2018-07乳腺科的250例乳头溢液患者,采用FDS检查,分析其诊断的价值,并分析FDS下特征表像在导管癌和非导管癌差异,并进一步分析特征表现区别良恶性疾病能力大小。结果 FDS诊断癌与术后病理报告的符合率为70. 0%,诊断导管内乳头状瘤符合率80. 0%,诊断导管内乳头状瘤病符合率66. 7%,总符合率为77. 3%。FDS鉴别诊断乳腺良恶性的灵敏度为73. 3%(11/15),特异度为89. 0%(73/82)。管壁是否光滑、瘤体是否带蒂、瘤体表面是否有颗粒、瘤体颜色区别、末梢出血量的多少在非导管癌与导管癌中具有明显的差异性,差异有统计学意义(P <0. 05)。管壁是否光滑区别导管癌与非导管癌的ROC曲线下面积为0. 79,瘤体是否带蒂区别导管癌与非导管癌的曲线下面积0. 78,瘤体表面是否有颗粒区别导管癌与非导管癌的曲线下面积0. 75,瘤体颜色导管癌与非导管癌的曲线下面积为0. 67,导管末梢是否大量出血区别导管癌与非导管癌的曲线下面积为0. 64。结论 FDS在乳头溢液中具有较好诊断价值,管壁情况、瘤体带蒂、瘤体表面颗粒对区别良恶性乳腺疾病具有重要的价值。
Objective To evaluate the diagnostic value of FDS in nipple discharge. Methods A total of 250 cases with nipple discharge and under the examination of FDS in Dazhou Central Hospital between July 2016 and July 2018 were selected,and the diagnostic value of FDS was determined. The difference of characteristics under FDS between ductal carcinoma and non-ductal carcinoma was analyzed. Results The coincidence rate between the diagnosis of FDS and pathology was 70. 0%,The coincidence rate in intraductal papilloma was 80. 3%,compared with 66. 7% for malignant intraductal papilloma. The total coincidence rate was 77. 3%.There was statistically significant difference( P < 0. 05) between ductal and non-ductal cancer in terms of the smoothness of the duct wall,presence of pedicles,presence of granules on the surface of the tumor,the color of the tumor,and the amount of blood loss at the end of the catheter. The area under the ROC curve was 0. 79 when the smoothness of the duct wall was used to distinguish ductal carcinoma from non-ductal carcinoma,compared to 0. 779 with tumor pedicles,0. 751 with the presence of granules on the tumor surface,0. 673 with the tumor color and 0. 645 with the amount of bleeding at the end of the catheter. Conclusions FDS is of good diagnostic value in nipple discharge,and some characteristic images under the nipple can contribute much to differentiating benign and malignant breast diseases.
Objective To evaluate the diagnostic value of FDS in nipple discharge. Methods A total of 250 cases with nipple discharge and under the examination of FDS in Dazhou Central Hospital between July 2016 and July 2018 were selected,and the diagnostic value of FDS was determined. The difference of characteristics under FDS between ductal carcinoma and non-ductal carcinoma was analyzed. Results The coincidence rate between the diagnosis of FDS and pathology was 70. 0%,The coincidence rate in intraductal papilloma was 80. 3%,compared with 66. 7% for malignant intraductal papilloma. The total coincidence rate was 77. 3%.There was statistically significant difference( P < 0. 05) between ductal and non-ductal cancer in terms of the smoothness of the duct wall,presence of pedicles,presence of granules on the surface of the tumor,the color of the tumor,and the amount of blood loss at the end of the catheter. The area under the ROC curve was 0. 79 when the smoothness of the duct wall was used to distinguish ductal carcinoma from non-ductal carcinoma,compared to 0. 779 with tumor pedicles,0. 751 with the presence of granules on the tumor surface,0. 673 with the tumor color and 0. 645 with the amount of bleeding at the end of the catheter. Conclusions FDS is of good diagnostic value in nipple discharge,and some characteristic images under the nipple can contribute much to differentiating benign and malignant breast diseases.
引文
[1]王建,陶爽,刘尧邦,等.FDS在病理性乳头溢液诊治中的应用价值[J].中国肿瘤外科杂志,2016,8(1):4-7.
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[4]刘熙鹏,郭莉,李园园.乳管内乳头状病变的临床分析:附1211报告[J].中国普通外科杂志,2013,22(11):1426-1430.
[5]郭涛,许彬,陈耀坤,等.乳头溢液128例外科治疗体会[J].临床普外科电子杂志,2014,2(4):23-25.
[6]Zieliński J,Jaworski R,Swierblewski M,et al.The evaluation of ductoscopy as a new diagnostic tool in diseases of the breast:our experiences and data from the literature[J].Nowotwory J Oncol,2010,60:116-121.
[7]马榕,吴土金.乳头溢液的诊断及对策[J].中国实用外科杂志,2016,36(7):738-741.
[8]王霞,张喜平.FDS在乳头溢液性疾病诊治中的应用[J].内蒙古医科大学学报,2015,6(6):497-501.
[9]Ferlay J F,Shin H R,Bray F,et al.Estimates of worldwide burden of cancer in 2008[J]:.Int J Cancer,2010,127:2893-2917.
[10]Kamali S,Harman K G,Akan A,et al.Use of ductoscopy asanadditional diagnostic method and its applications in nipple dis charge[J].Minerva Chir,2014,69(2):65-73.
[11]朱彩霞,王颀,邓群娣,等.纤维FDS检查分级在乳头血性溢液疾病诊断中的应用价值[J].中华乳腺病杂志:电子版,2011,5(2):171-179.
[12]王霞,陈楠,宋张骏,等.纤维FDS对乳腺导管内肿瘤的诊断价值[J].现代肿瘤医学,2014,22(4):847-850.
[13]边学海,孙辉.乳头溢液的个体化诊断流程[J].中国普外基础与临床杂志,2015,13(6):652-655.
[14]张腾华.FDS在诊断与治疗乳头溢液中的临床应用价值分析[J].中国妇幼保健,2011,26(14):2208-2209.
[15]吴涛,李怡,何显力,等.FDS用于乳腺导管内乳头状瘤的临床诊治研究[J].现代肿瘤医学,2012,20(6):1173-1174.
[16]吴唯,钱立元,丁波泥,等.1368例FDS治疗乳管内病变的临床应用经验[J].中国肿瘤临床,2014,4(3):254-258.
[17]Al Sarakbi W,Salhab M,Mokbel K.Does mammary duct endoscopy have a role in clinical practice?[J].Int Semin Surg Oncol,2006,3:16.
[2]Kamali S,Bender O,Kamali G H,et al.Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods[J].Breast Cancer,2014,21(2):154-161.
[3]徐晓洲,王靖,王仲照,等.乳管内视镜定位在乳导管解剖术中的应用[J].中华肿瘤杂志,2008,30(3):234-236.
[4]刘熙鹏,郭莉,李园园.乳管内乳头状病变的临床分析:附1211报告[J].中国普通外科杂志,2013,22(11):1426-1430.
[5]郭涛,许彬,陈耀坤,等.乳头溢液128例外科治疗体会[J].临床普外科电子杂志,2014,2(4):23-25.
[6]Zieliński J,Jaworski R,Swierblewski M,et al.The evaluation of ductoscopy as a new diagnostic tool in diseases of the breast:our experiences and data from the literature[J].Nowotwory J Oncol,2010,60:116-121.
[7]马榕,吴土金.乳头溢液的诊断及对策[J].中国实用外科杂志,2016,36(7):738-741.
[8]王霞,张喜平.FDS在乳头溢液性疾病诊治中的应用[J].内蒙古医科大学学报,2015,6(6):497-501.
[9]Ferlay J F,Shin H R,Bray F,et al.Estimates of worldwide burden of cancer in 2008[J]:.Int J Cancer,2010,127:2893-2917.
[10]Kamali S,Harman K G,Akan A,et al.Use of ductoscopy asanadditional diagnostic method and its applications in nipple dis charge[J].Minerva Chir,2014,69(2):65-73.
[11]朱彩霞,王颀,邓群娣,等.纤维FDS检查分级在乳头血性溢液疾病诊断中的应用价值[J].中华乳腺病杂志:电子版,2011,5(2):171-179.
[12]王霞,陈楠,宋张骏,等.纤维FDS对乳腺导管内肿瘤的诊断价值[J].现代肿瘤医学,2014,22(4):847-850.
[13]边学海,孙辉.乳头溢液的个体化诊断流程[J].中国普外基础与临床杂志,2015,13(6):652-655.
[14]张腾华.FDS在诊断与治疗乳头溢液中的临床应用价值分析[J].中国妇幼保健,2011,26(14):2208-2209.
[15]吴涛,李怡,何显力,等.FDS用于乳腺导管内乳头状瘤的临床诊治研究[J].现代肿瘤医学,2012,20(6):1173-1174.
[16]吴唯,钱立元,丁波泥,等.1368例FDS治疗乳管内病变的临床应用经验[J].中国肿瘤临床,2014,4(3):254-258.
[17]Al Sarakbi W,Salhab M,Mokbel K.Does mammary duct endoscopy have a role in clinical practice?[J].Int Semin Surg Oncol,2006,3:16.