乳管镜、乳腺钼靶、高频彩色多普勒超声对乳头血性溢液合并乳管内占位性病变的诊断价值

Clinical value of ductoscopy, mammography, and high-frequency color Doppler ultrasonography in diagnosis of nipple bloody discharge combined with intraductal space occupying lesions

摘要:

目的 分析乳管镜、乳腺钼靶、高频彩色多普勒超声在乳头血性溢液合并乳管内占位性病变诊断中的临床意义。方法 回顾性分析2023年1月－2023年12月该院收治的行手术治疗的198例乳头血性溢液合并乳管内占位性病变患者的临床资料，术前对所有纳入对象进行乳管镜、乳腺钼靶、高频彩色多普勒超声检查。将术后病理结果作为金标准，评估单独运用及联合运用上述三种检查手段诊断乳头血性溢液合并乳管内占位性病变的效能。结果 经术后病理诊断结果显示，乳腺导管内良性病变152例，均为乳腺导管内乳头状瘤；恶性病变46例，25例乳腺导管内癌，21例浸润性导管癌。乳头血性溢液合并乳管内占位性病变经乳管镜、乳腺钼靶、高频彩色多普勒超声及三者联合检查的检出率分别为95.45%、81.31%、84.85%和97.47%；其中，乳管镜和三者联合检查的检出率明显高于乳腺钼靶和高频彩色多普勒超声（P < 0.05），乳管镜和三者联合检查的检出率组间比较，无明显差异（P > 0.05），乳腺钼靶和高频彩色多普勒超声的检出率组间比较，无明显差异（P > 0.05）。乳管镜诊断乳头血性溢液合并乳管内占位性病变的敏感度、特异度和准确度分别为91.30%、97.20%和95.77%，乳腺钼靶分别为65.00%、94.21%和86.96%，高频彩色多普勒超声分别为70.73%、96.06%和89.88%，三者联合分别为95.65%、97.28%和96.89%。三者联合检查和单用乳管镜诊断乳头血性溢液合并乳管内占位性病变的敏感度和准确度都明显高于乳腺钼靶和高频彩色多普勒超声（P < 0.05），而乳腺钼靶和高频彩色多普勒超声组间比较，差异无统计学意义（P > 0.05），三者联合检查和单用乳管镜组间比较，差异无统计学意义（P > 0.05）。4种诊断特异度比较，差异无统计学意义（P > 0.05）。结论 乳管镜对乳头血性溢液合并乳管内占位性病变的诊断敏感度和准确度明显高于乳腺钼靶和高频彩色多普勒超声，且三者联合检查一定程度上能提高诊断效能，但效果有限。

Abstract:

Objective To analyze the clinical significance of ductoscopy, mammography, and high-frequency color Doppler ultrasonography in diagnosis of nipple bloody discharge combined with intraductal space occupying lesions.Methods The medical records of 198 patients with nipple bloody discharge combined with intraductal space occupying lesions who underwent surgical treatment from January 2023 to December 2023 were retrospectively analyzed, all the subjects were examined by ductoscopy, mammography and high-frequency color Doppler ultrasonography before operation. The results of postoperative pathology were used as the gold standard to compare and evaluate the efficacy of single and combined use of the above three methods in the diagnosis of nipple bloody discharge combined with intraductal space occupying lesions.Results The results of postoperative pathological diagnosis showed that 152 cases of intraductal benign lesions were intraductal papilloma of the breast. There were 46 malignant lesions, of which 25 were intraductal carcinoma and 21 were invasive ductal carcinoma. The detection rates of nipple bloody discharge combined with intraductal space occupying lesions were 95.45%, 81.31%, 84.85% and 97.47%, respectively, by ductoscopy, mammography, high-frequency color Doppler ultrasonography and combined examination. Among them, the detection rate of ductoscopy and combined examination were significantly higher than that of mammography and high-frequency color Doppler ultrasonography (P < 0.05), there was no significant difference between the detection rate of ductoscopy and combined examination (P > 0.05), and there was no significant difference between the detection rate of mammography and high-frequency color Doppler ultrasonography (P > 0.05). The sensitivity, specificity, and accuracy of diagnosing nipple bloody discharge combined with intraductal space occupying lesions using ductoscopy were 91.30%, 97.20%, and 95.77%, respectively. The above indicators of mammography were 65.00%, 94.21%, and 86.96%, respectively. The above indicators of high-frequency color Doppler ultrasonography were 70.73%, 96.06%, and 89.88%, respectively. The above indicators of combination of the three methods were 95.65%, 97.28%, and 96.89%, respectively. The sensitivity and accuracy of the combined examination of the three methods and the use of ductoscopy alone for the diagnosis of nipple bloody discharge combined with intraductal space occupying lesions were significantly higher than those of mammography and high-frequency color Doppler ultrasonography (P < 0.05). However, there was no significant difference between mammography and high-frequency color Doppler ultrasonography (P > 0.05), and there was also no significant difference between the combined examination of the three methods and the use of ductoscopy alone (P > 0.05). There was no significant difference in diagnostic specificity among the four groups (P > 0.05).Conclusion The diagnostic sensitivity and accuracy of ductoscopy for nipple bloody discharge combined with intraductal space occupying lesions are significantly higher than those of mammography and high-frequency color Doppler ultrasonography. The combined examination of the three can improve diagnostic efficiency to a certain extent, but the effect is limited.