| Objective: To analyze the clinical characteristics of patients with pathological nipple discharge(PND),and to provide objective basis for early diagnosis of patients with nipple discharge.Methods: A total of 3503 cases of PND patients with menstrual fiber ductoscope(FDS)were collected from November 2005 to November 2020 in our center.The characteristics of the patient’s age,course of disease,amount of discharge,nature(bloody,yellow serous,colorless or white),cavity of the discharge(single or porous),site of the breast(unilateral or bilateral)and the microscopic diagnosis(space-occupying or non-space-occupying lesions)were comprehensively analyzed.Focusing on the differences in clinical manifestations between patients with intraductal space occupying lesions and patients with non-space occupying lesions diagnosed by FDS,combining with pathological diagnosis,ultrasound and molybdenum target examination,the different characteristics of nipple discharge caused by different etiology were explored,and the factors for differential diagnosis of breast cancer and benign lesions were analyzed.Results :3503 PND patients ranged in age from 14 to 84 years old,with a mean age of43.6 and a median age of 43.6 years.More than half(61.36%)of the patients were aged between 31 and 50.The overflow time is 1 day to 30 years.Most of the patients had unilateral discharge(84.37%)and single pore discharge(73.74%),and the amount was small(69.97%).Yellow serous discharge was the most common(38.30%),followed by bloody discharge(37.90%).The results of FDS diagnosis showed that there were 1661cases(47.42%)of space occupying lesions in milk ducts,and 1842 cases(52.58%)of non-space occupying lesions.The patients with nipple discharge over 40 years old are the main population of space occupying lesions in the milk ducts.Their characteristics are as follows: unilateral and single hole discharge is the main one,with large amount and more bleeding,and there is no correlation with the duration of the disease.Among the 3503 patients,929 cases were pathologically obtained by surgical treatment,including 687 cases of papilloma(73.95%),136 cases of ductectasis and ductitis(14.64%),66 cases of breast malignancy(7.10%),25 cases of infiltrating carcinoma,39 cases of carcinoma in situ,2 cases of mucinous carcinoma),and 24 cases of severe dysplasia(2.58%).There were 11 cases of breast adenosis(1.18%)and 5 cases of breast fibroadenoma(0.54%).Of66 cases of breast cancer,53 cases(80.30%)were bleeding,16 cases(66.67%)of 24 cases of severe dysplasia were bleeding,316 cases(46.00%)of 687 cases of papilloma were bleeding,and 298 cases(43.38%)were light yellow serous.Among 136 cases of ductectasis and ductitis,61 cases(44.85%)were bleeding,49 cases(36.03%)were pale yellow serous.Single factor analysis showed that age,time of discharge,side of discharge,nature of discharge,amount of discharge,molybdenum target examination results and ultrasonic examination results were related to breast cancer.The multivariate analysis showed that hemorrhagic discharge and target return BI-RADS 4B and above were two important independent risk factors for breast cancer with nipple discharge.Among 66 breast cancer patients with nipple discharge as the first symptom,the average age was 52.4(25-84).Among them,54 cases(81.82%)had hemorrhagic discharge.The accuracy rate of ultrasonic examination was 22.58%,the accuracy rate of molybdenum target examination was 55.81%,and the accuracy rate of freezing pathology examination was 72.13%.Postoperative pathology included 39 cases of carcinoma in situ,25 cases of infiltrating carcinoma and 2 cases of mucinous carcinoma.The longest median diameter of the tumor was 0.3cm,50 cases with long diameter ≤1cm,and 60 cases with long diameter ≤2cm.56 cases were ER positive,52 cases were PR positive,39 cases were Ki-67 low proliferation(< 14%+).A total of 39 cases of lymph node biopsy were detected in 6 cases with lymph node metastasis.45 cases(68.18%)of luminal type A breast cancer.Pathological staging showed stage 0 in 39 cases(59.09%)and stage IA in18 cases(27.27%).Conclusion: PND usually occurs at the age of 31 to 50 years,and is mostly unilateral,single pore,yellow serous discharge.Factors with important reference value for judging the presence or absence of milk duct lesions included age,discharge amount,discharge nature,discharge cavity and location of affected milk,which had no relation to the course of disease.Most of the overflow of papilloma is blood or light yellow serous,and the vast majority of breast cancer and precancerous lesions are blood.Blood discharge and molybdenum target return BI-RADS 4B and above are independent risk factors for nipple discharge as symptomatic breast cancer.Ductal carcinoma in situ(DCIS)was the main malignant tumor with nipple discharge as the first symptom.The tumor focus was small,most lymph nodes were negative,the stage was early,the positive rate of ER and PR expression was high,and luminal type A was the majority of pathological molecular typing. |
