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中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 431 -434. doi: 10.3877/cma.j.issn.1674-3946.2023.04.021

论著

超声乳管造影联合亚甲蓝染色在乳头溢液手术中的可行性研究
颜敏, 周莉娜, 钱海蓉, 姜一坤, 顾瑞香, 刘学敏, 常清语, 王海强()   
  1. 215600 江苏张家港,南京中医药大学附属张家港医院甲乳外科
    215600 江苏张家港,南京中医药大学附属张家港医院普外二科
  • 收稿日期:2022-10-26 出版日期:2023-08-26
  • 通信作者: 王海强

Feasibility study of ultrasound mammography combined with methylene blue staining in the operation of nipple discharge

Min Yan, Lina Zhou, Hairong Qian, Yikun Jiang, Ruixiang Gu, Xuemin Liu, Qingyu Chang, Haiqiang Wang()   

  1. Department of Medicine A Breast Surgery, Zhangjiagang Hospital affiliated to Nanjing University of Traditional Chinese, Zhangjiagang Jiangsu Province 215600, China
    General Outside the Second, Zhangjiagang Hospital affiliated to Nanjing University of Traditional Chinese, Zhangjiagang Jiangsu Province 215600, China
  • Received:2022-10-26 Published:2023-08-26
  • Corresponding author: Haiqiang Wang
  • Supported by:
    Youth Project of Natural Science Foundation of Jiangsu Province(BK20191078)
引用本文:

颜敏, 周莉娜, 钱海蓉, 姜一坤, 顾瑞香, 刘学敏, 常清语, 王海强. 超声乳管造影联合亚甲蓝染色在乳头溢液手术中的可行性研究[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(04): 431-434.

Min Yan, Lina Zhou, Hairong Qian, Yikun Jiang, Ruixiang Gu, Xuemin Liu, Qingyu Chang, Haiqiang Wang. Feasibility study of ultrasound mammography combined with methylene blue staining in the operation of nipple discharge[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 431-434.

目的

分析超声乳管造影联合亚甲蓝染色在乳头溢液手术中的可行性。

方法

回顾性选取2019年1月至2021年12月38例乳头溢液患者,均行钼靶乳管造影和超声乳管造影检查,术前12 h联合亚甲蓝染色;观察术中亚甲蓝染色率、造影方法的影像显影及病变位置分布。采用统计学软件SPSS 22.0进行数据分析,计数资料用[例(%)]表示,组间比较采用χ2检验;ROC曲线分析超声乳管造影和钼靶乳管造影对乳头溢液的诊断价值。P<0.05表示差异有统计学意义。

结果

38例患者经常规超声检查共发现44处病灶,术中亚甲蓝染色率为100%,以术后组织病理学检查结果为金标准,结果显示超声乳管造影的准确度显著高于钼靶乳管造影(93.2% vs.75.0%),假阴性率显著低于钼靶乳管造影(5.0% vs. 22.5%),差异均有统计学意义(P<0.05)。超声乳管造影诊断乳头溢液的AUC为0.867,高于钼靶乳管造影(0.766)。

结论

超声乳管造影联合亚甲蓝染色可对溢液乳管进行术前定位,明确病变位置,提高乳头溢液的检出率,同时可精准切除病灶,减少对正常乳腺组织的损伤。

Objective

To analyze the feasibility of ultrasound mammography combined with methylene blue staining in the operation of nipple discharge.

Methods

A total of 38 patients with nipple discharge from January 2019 to December 2021 were retrospectively selected. All of them underwent mammography and ultrasound mammography,combined with methylene blue staining 12 h before surgery. The methylene blue staining rate,imaging development and lesion location were observed. Statistical software SPSS 22.0 was used for data analysis. The counting data were represented by[n(%)],and the comparison between groups was performed by χ2 test. ROC curve was used to analyze the diagnostic value of ultrasound and mammography in nipple discharge. P<0.05 indicated that the difference was statistically significant.

Results

A total of 44 lesions were found by routine ultrasonography in 38 patients,and the methylium-blue staining rate was 100%. The results of postoperative histomatological examination were used as the gold standard. The results showed that the accuracy of ultrasonography was significantly higher than that of mammography(93.2%vs.75.0%). The false negative rate was significantly lower than that of mammography(5.0%vs.22.5%),and the differences were statistically significant(P<0.05). The AUC for the diagnosis of nipple discharge by ultrasonography was 0.867,which was higher than that by mammography(0.766).

Conclusion

Ultrasonography combined with methylene blue staining can locate the leaking milk duct before surgery,identify the lesion location,improve the detection rate of nipple discharge,and accurately remove the lesion to reduce the damage to normal breast tissue.

表1 38例乳头溢液患者超声乳管造影和钼靶乳管造影诊断结果(例)
表2 38例乳头溢液患者不同检查方法的显影及病变位置分布
图1 超声乳管造影和钼靶乳管造影诊断乳头溢液的ROC曲线
[1]
杜红雁,雷莹. 病理性乳头溢液临床病理分析[J]. 诊断病理学杂志202229(03):221-224.
[2]
Filipe MDPatuleia SISVriens MR,et al. Meta-analysis and cost-effectiveness of ductoscopy,duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge[J]. Breast Cancer Res Treat2021186(2):285-293.
[3]
徐颖,孙强,周星彤,等. 173例病理性乳头溢液临床病理特点及诊治分析[J].协和医学杂志201910(06):692-697.
[4]
Gupta DMendelson EBKarst I. Nipple Discharge:Current Clinical and Imaging Evaluation[J]. AJR Am J Roentgenol2021216(2):330-339.
[5]
汤程旭,陈文龙,杨蕊. MRI联合钼靶X线在乳腺导管原位癌的诊断价值[J/CD].中华普外科手术学杂志(电子版)202014(05):480-482.
[6]
原晓燕,李智,张璐,等. 乳管镜在病理性乳头溢液中的诊断价值[J]. 中华保健医学杂志202123(05):499-501.
[7]
Gupta DMendelson EBKarst I. Nipple Discharge:Current Clinical and Imaging Evaluation[J]. AJR Am J Roentgenol2021216(2):330-339.
[8]
Srinivasan ANia EGupta M,et al. Retrospective statistical analysis on the diagnostic value of ductography based on lesion pathology in patients presenting with nipple discharge[J]. Breast J201925(4):585-589.
[9]
Filipe MDSimons JMMoeliker L,et al. Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge[J]. Breast Cancer202128(2):471-477.
[10]
王利鸽,蔡礼华. 乳腺钼靶X线摄影和超声检查对乳腺导管内癌的诊断价值[J]. 实用医学影像杂志202122(03):283-284.
[11]
Zhou YLiang YZhang J,et al. Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions:A Comparative Study[J]. Front Surg20218:757694.
[12]
Hao NYuan XWang Q,et al. The role of magnetic resonance imaging in detection and surgical treatment of breast intraductal papillomas[J]. Transl Cancer Res20198(2):635-646.
[13]
吕复君,丁丹丹,冀峰,等. 双乳钼靶正常的乳头溢液临床研究[J]. 中国现代医药杂志202022(06):63-65.
[14]
Fallenberg EM. Kontrastmittelunterstützte Mammographie Contrast-enhanced mammography[J]. Radiologe202161(2):177-182.
[15]
韩转宁,郭宏斌,杨宝林,等. 超声造影引导下导丝定位联合纳米碳染色对乳腺癌SLN的定位效果分析[J/CD]. 中华普外科手术学杂志(电子版)202014(01):54-57.
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