乳腺导管切除术是病理性乳头溢液明确诊断的金标准。不过，由于大多数病理性乳头溢液为自限性且为良性，故乳腺导管切除术存在过度治疗的问题。乳腺导管内窥镜检查有助于诊断，并分流患者进行干预或进行观察。
2020年2月1日，日本乳腺癌学会《乳腺癌》在线发表中国香港玛丽医院、香港大学深圳医院、香港大学医学院邝霭慧等学者的研究报告，探讨了乳腺导管内窥镜检查能否减少不必要的乳腺导管切除术，而不耽误恶性肿瘤的诊断。
该多中心回顾研究对2016年1月～2018年12月香港玛丽医院、香港东华医院、香港大学深圳医院连续223例常规影像检查未发现可疑的病理性乳头溢液乳腺导管内窥镜检查患者进行回顾分析。如果发现乳腺导管内病变，那么尝试通过乳腺导管内窥镜切除。如果乳腺导管内病变阳性，但是通过内窥镜切除失败，或乳腺导管内窥镜检查失败且病理性乳头溢液持续，那么进行乳腺导管切除术。根据插管成功比例、避免手术数量、恶性肿瘤漏诊数量，判断乳腺导管内窥镜检查的有效性。
结果，插管成功比例为94.2%，其中导管内肿块125例（59.5%），并进行了82例乳腺导管切除术，最终组织学确诊恶性肿瘤15例（6.7%）。
对成功进行乳腺导管内窥镜检查且阴性的85例患者（37.8%）进行分流监测，中位2年随访期间，恶性比例为0%，故避免了乳腺导管切除术。
因此，该研究结果表明，对于常规影像检查未发现可疑的病理性乳头溢液，乳腺导管内窥镜检查阴性患者的恶性肿瘤发生率微乎其微，随后无需进行乳腺导管切除术。不过，乳腺导管内窥镜检查发现的导管内肿块是恶性肿瘤预测因素，故必须进行最终组织学确诊。
Breast Cancer. 2020 Feb 1. [Epub ahead of print]
Could ductoscopy alleviate the need of microdochectomy in pathological nipple discharge?
Yuk-Kwan Chang, Clement Tzu-Hsin Chen, Min Wang, Yong Yang, Bonita Mark, Ai-qiu Zheng, Ava Kwong.
Queen Mary Hospital, Hong Kong, China; The University of Hong Kong - Shenzhen Hospital, Shenzhen, China; The University of Hong Kong, Hong Kong, China.
BACKGROUND: Microdochectomy is the gold-standard for definitive diagnosis for pathological nipple discharge (PND); however, problem of over-treating exists since majority of PND are self-limiting and due to benign causes. Ductoscopy may assist diagnosis, and triage patients for intervention or expectant management. This study aimed to evaluate if ductoscopy could reduce unnecessary microdochectomy but not compromising the diagnosis of malignancy.
METHOD: A multicenter, retrospective study was conducted in consecutive patients of PND without a suspected malignancy on routine diagnostic evaluation. Ductoscopy was performed with attempts to remove intraductal lesions if they were found. Microdochectomy was carried out if there were positive intraductal lesions, but failed endoscopic extraction, or failed ductoscopy and persistent PND. Efficacy of ductoscopy was determined by cannulation success rate, number of avoided surgery and number of missed malignancy.
RESULTS: In a 3-year period between 2016 and 2018, a total of 223 ductoscopy were performed and 94.2% had successful cannulation. Within such, 59.5% (N=125) had intraductal mass identified, and 82 microdochectomy were carried out. The final histology showed 15 malignancy, making the overall malignancy rate 6.7%. Ductoscopy successful and negative patients (N=85, 37.8%) were triaged for surveillance and the malignancy rate is 0% in a median follow-up of 2 years; hence, microdochectomy was avoided.
CONCLUSION: PND with non-suspicious conventional imaging and negative ductoscopy have rare malignancy rate which makes subsequent microdochectomy unnecessary. However, intraductal mass in ductoscopy is a predictor for malignancy so definitive histology diagnosis is mandatory.
KEYWORDS: Nipple discharge; Ductoscopy; Microdochectomy; Intraductal carcinoma
DOI: 10.1007/s12282-020-01051-w
联系客服
