【摘要】 目的乳腺导管内病变与乳腺癌的发展密切相关。导管内病变主要表现为病理性乳头溢液(pathological nipple discharge,PND),而近年发现部分导管内病变患者无PND的临床表现,从而被临床医师忽略。本研究探讨无PND患者中导管内病变的危险因素及影像特点。方法回顾性分析2016-04-01-2017-02-28吉林大学中日联谊医院乳腺外科行手术治疗的281例无PND患者的术后病理资料。根据病理结果将患者分为导管内病变组和非导管内病变组,收集临床、影像资料进行单因素和Logistic多因素回归分析。分析无PND患者导管内病变的危险因素和影像特点。结果281例无PND患者共370个病变乳房(89例患者为双侧同类型病变),导管内病变患者127例(45.20%)、非导管内病变患者154例(54.80%);术后病理诊断为导管内病变乳房156个、非导管内病变乳房214个。单因素分析显示,年龄(χ~2=29.937,P<0.001)、妊娠次数(χ~2=10.471,P=0.001)、流产次数(χ~2=6.151,P=0.013)、非经期乳房疼痛(χ~2=52.945,P<0.001)在导管内病变组与非导管内病变组之间差异有统计学意义。Logistic多因素回归分析结果显示,年龄35~50岁(OR=4.346)和>50岁(OR=5.939)、非经期乳房疼痛(OR=6.720)为无PND患者导管内病变的独立危险因素。所有病变乳房影像资料分析发现超声下导管扩张(χ~2=21.947,P<0.001)、病变直径(χ~2=16.824,P<0.001)和病变距乳头的距离(χ~2=15.171,P<0.001)在导管内病变与非导管内病变之间差异有统计学意义。结论对于年龄>35岁、伴有与经期无关的乳房疼痛、乳腺导管扩张、肿物距乳头距离≤2cm和病变≤1cm的自然就诊人群,尽管没有出现PND,仍应高度关注乳管内病变存在的可能性,减少漏诊和误诊。更多还原

【Abstract】 OBJECTIVE Intraductal lesions are closely related to the development of breast cancer and mainly manifested as pathological nipple discharge(PND).In recent years,some patients with intraductal lesions were found without PND,which may result in the missed diagnosis or misdiagnosis in clinic.The purpose of this study was to investigate the risk factors and imaging features of intraductal lesions in patients without PND.METHODS This study retrospectively(2016-04-01 to 2017-02-28)analyzed postoperative pathological data of 281 patients without PND who underwent surgical treatment at the Department of Breast Surgery,China-Japan Union Hospital of Jilin University.According to the pathological results,patients were divided into intraductal lesions group and non-intraductal lesions group.The clinical and imaging data were collected to analyze the risk factors and imaging features of intraductal lesions in patients without PND.RESULTS A total of 281 patients without PND with 370 diseased breasts(89 patients with bilateral lesions of the same type),127(45.20%)with intraductal lesions,and 154(54.80%)with non-intraductal lesions;postoperative pathological diagnosis of intraductal lesions in 156 cases,diagnosed as non-intraductal lesions in 214 cases.Univariate analysis showed that age(χ~2=29.937,P<0.001),number of pregnancies(χ~2=10.471 P=0.001),number of abortions(χ~2=6.151,P=0.013)and non-menstrual breast pain(χ~2=52.945,P<0.001)were significantly different between the two groups.Multivariate logistic regression analyses showed that age in 35-50 years old and age>50 years old(OR=4.346/OR=5.939),non-menstrual breast pain(OR=6.720)were the risk factors of intraductal lesions in patients without PND.Analysis of all diseased breast imaging features revealed that there was a statistically significant difference in the duct ectasia(χ~2=21.947,P<0.001),the lesion size(χ~2=16.824,P<0.001)and the lesion distance from the nipple(χ~2=15.171,P<0.001)between lesions and non-intraductal lesions.CONCLUSION For people who aged over 35,accompanying non-menstrual breast pain and ultrasound showed duct ectasia,the lesion distance from nipple≤2 cm and the lesion size≤1 cm,although there is no PND occurred,clinicians should still be highly concerned about the possibility of intraductal lesions,to reduce missed diagnosis and misdiagnosis rate.更多还原