目的 探讨以乳头溢液为唯一临床表现的乳腺癌临床病理特征与诊治。方法 收集本院自2010年至2018年以乳头溢液为唯一临床表现,乳腺X线摄影和超声筛查阴性的75例乳腺癌病人资料,对其临床病理特征、影像学表现、治疗方式以及预后进行回顾性分析。结果 病人均为女性,平均年龄（52.9±13.4）（27~78）岁。血性溢液71例（94.7%）。22例病人术前行乳腺增强MRI检查,阳性结果（BIRADS≥4类）17例（77.3%）。65例行术中冷冻病理检查,其中38例提示良性病变（58.5%）,27例恶性病变（41.5%）。术后病理类型包括导管原位癌29例,导管内实性乳头状癌39例,浸润性导管癌6例,浸润性黏液癌1例。病灶中位最长径为 1.0（0.2~6.0） cm,58例（77.3%）<2 cm。68例ER阳性,62例PR阳性,71例Ki-67低增殖（<20%+）。8例接受保乳手术,67例接受全乳切除术。59例接受前哨淋巴结活检,5例接受腋窝淋巴结清扫,均无淋巴结转移。11例未行腋窝淋巴结活检。68例接受辅助内分泌治疗,2例浸润性癌病人接受术后辅助化疗。无复发、转移病例。结论 以乳头溢液为唯一临床表现的乳腺癌以血性溢液多见,增强MRI具有较高的诊断价值。术中冷冻病理诊断较困难,病理类型以导管原位癌和乳头状癌为主,病灶体积相对较小,通常不伴腋窝淋巴结转移,临床分期早,预后良好。
Objective To investigate the clinicopathological characteristics including diagnosis and treatment of breast cancer with nipple discharge as only presenting symptom. Methods The data of 75 patients with breast cancer in our hospital from 2010 to 2018 with nipple discharge as only presenting symptom and mammography or ultrasound exams negative were collected. A retrospective analysis was done with clinicopathological data including imaging, therapy and prognosis. Results All cases were female with mean age (52.9± 13.4) (27-78) years old. Seventy-one cases (94.7%) had bloody nipple discharge. Of 22 cases who underwent enhancement magnetic resonance imaging (MRI), 17 cases (77.3%) were positive with BIRADS category 4 or higher. Sixty-five cases underwent intraoperative frozen section pathology, of which 38 (58.5%) cases were benign lesions and 27 (41.5%) cases were malignant lesions. Pathological types included ductal carcinoma in situ (n=29), solid papillary carcinoma (n=39), invasive ductal carcinoma (n=6), and invasive mucinous carcinoma (n=1). The largest diameter of focus including papillary carcinoma and in situ carcinoma was from 0.2 cm to 6.0 cm with the median of 1.0 cm and the diameter less than 2 cm in 58 (77.3%) cases. Estrogen receptor was positive in 68 cases, progesterone receptor positive in 62 cases and Ki-67 low proliferation (<
20%) in 71 cases. Eight cases underwent breast-conserving surgery, 67 cases with mastectomy. There were 59 cases with sentinel lymph node biopsy, and 5 cases with axillary lymph node dissection. No lymph node metastasis was detected. Totally, 11 cases did not receive axillary lymph node biopsy. Adjuvant endocrine therapy was given to 68 cases and adjuvant chemotherapy to 2 cases with invasive carcinoma. There was no recurrence nor metastasis case. Conclusions Bloody nipple discharge was found in most patients of breast cancer with nipple discharge as only presenting symptom. Enhanced MRI would have great help for diagnosis. Intraoperative frozen sections biopsy had less positive for diagnosis of breast cancer. Most pathological types were ductal carcinoma in situ and papillary carcinoma with lesions small. The good prognosis was seen due to early clinical stage and no axillary lymph node metastasis.
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