Clinical Application Of Intraductal Endoscopy For Bilateral Pathological Nipple Discharge

Objective:To apply and analyze the value of intraductal endoscopy for the diagnosis and clinical features of bilateral pathological nipple discharge.Methods: 1193 patients were diagnosed with bilateral nipple discharge between June 2006 to December 2007.Among them,534 Physiological and medicamentus nipple discharge were excluded,and remained the 659 patients were performed by thyroid function, prolactin,estradiol,progesterone-examination.Those patients increased their levels of prolactin and milk-like discharge.All the 659 patients were performed by intraductal endoscopy,and the 307 cases with intraductal space-occupying lesion had pathologic changes.Results:Among the 659 patients,there were 328 patients with intra-duct occupying lesions,and 331 with inflammatory intra-duct dilation.All the patients with intra-duct occupyed lesions were surgically resected.Post-operative consistent rate was 93.60%(307/328),and there was no breast cancer being detected.Clinical characteristics of the 659 patients with bilateral pathological nipple discharge.The distribution of different diseases may be in different age groups(P＜0.05),and the inflammatory intra-duct dilation can be mainly found in the patients with the age between years 20-30(40%),however in the patients over 30 intra-duct papilloma can be alse found at 35.94%,42.86%,49.38%,respectively(see Graph 5);The features of the discharge caused by different diseases showed sigificantly different(P＜0.05).The patients with hypothyroidism plus intra-duct papilloma or inflammatory intra-duct dilation mainly appeared as water-like discharge,micro-pituitary adenoma(with intra-duct papilloma or inflammatory intra-duct dilation) may cause milk-like discharge;and the ductal breast papilloma mainly cause serous and bloody discharge;inflammatory intra-duct dilation may cause yellow sticky-like and serosity discharge.The distribution of those diseases in different ethnical groups showed statisticaly different(P＜0.05).In all ethnical groups with the ductal papilloma,was most common,especially in Han people.The patients with hypothyroidism plus intra-duct papilloma was mainly observed in Kazak.Mainly in other minority,hypothyroidism,micro-pituitary adenoma with intra-duc papilloma mainly in Kazak;inflammatory intra-duct dilation in Uyghur.The distribution of breast pain in the different mammary diseases was different(p＜0.05).Breast pain mainly occurred in the patients with inflammatory intra-duct dilation with 71.21%,66.98%,64.02%, respectively(see Table 6).The distribution of the 307 patients with intra-ductal papilloma was significantly different(p＜0.05),and mainly located in the gradeⅡ,Ⅲduct.The bilateral and one side of the 307 patients with intra-ductal papilloma seems to be no statistically different(p＞0.05).Conclusion:(1) Intraductal endoscopies can be consided as an effective diagnostic tool for the ductal disease.(2)nipple discharge caused by hypothyroidism,micro-pituitary adenoma may hanve accompany with intra-ductal lesions.