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目的探讨不同临床及影像学特征对良性及恶性乳头溢液疾病的诊断价值。方法回顾性分析2011年1月至2016年2月上海交通大学医学院附属瑞金医院因乳头溢液行手术治疗的233例病人的临床资料。乳腺癌33例(14.2%),乳腺良性疾病200例(85.8%)。分析不同临床及影像学特征病人良性及恶性乳头溢液的检出率,计算乳腺X线摄影、乳腺超声、乳腺MRI及联合检查对乳腺癌诊断的灵敏度。结果血性溢液(P=0.008)、乳腺X线摄影伴可疑恶性钙化(P<0.001)、MRI表现为段样强化(P=0.003)、流出型时间-信号强度曲线(P=0.023)的病人乳腺癌检出率明显增高,差异有统计学意义。乳腺X线摄影对恶性乳头溢液诊断的灵敏度较低(57.6%),劣于超声检查(87.9%,P=0.012)及MRI检查(93.9%,P=0.001)。乳腺X线摄影联合超声或MRI诊断的灵敏度分别为90.9%及100.0%,显著高于单用乳腺X线检查(P=0.004,P<0.001)。结论对于不伴肿块的乳头溢液,血性溢液、乳腺X线摄影伴可疑恶性钙化、MRI段样强化、时间-信号强度曲线为流出型的病人患乳腺癌的风险较高。乳腺X线摄影对乳头溢液潜在恶性病变的检出率较低,联合超声或MRI检查可提高检出率。
Objective To investigate the diagnostic value of different clinical and radiological features in patients with benign and malignant papillary discharge. Methods The clinical data of 233 patients who undergone surgical treatment of nipple discharge at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to February 2016 were retrospectively analyzed. Breast cancer in 33 cases (14.2%), breast benign disease in 200 cases (85.8%). To analyze the detection rate of benign and malignant nipple discharge in patients with different clinical and imaging features, and calculate the sensitivity of mammography, mammography, breast MRI and combined examination to the diagnosis of breast cancer. Results Patients with bloody discharge (P = 0.008), mammography with suspected malignant calcification (P <0.001), MRI with segmental enhancement (P = 0.003) and outflow time-signal intensity curve Breast cancer detection rate was significantly higher, the difference was statistically significant. The sensitivity of mammography in the diagnosis of malignant papillary discharge was lower (57.6%), worse than that of ultrasound (87.9%, P = 0.012) and MRI (93.9%, P = 0.001). The sensitivity of mammography combined with ultrasound or MRI was 90.9% and 100.0% respectively, which was significantly higher than that of single mammography (P = 0.004, P <0.001). CONCLUSIONS: There is a high risk of developing breast cancer in patients with effusive nipple discharge, bloody discharge, mammographic suspicious malignant calcification, MRI-like enhancement, and time-versus-intensity curves. Mammography has a lower detection rate of potentially malignant lesions of the nipple discharge, and joint ultrasound or MRI can improve the detection rate.