| Objective: 1.By the clinical data of a large sample of female breast diseases optimal diagnostic classification of scientific credibility. 2. By large-scale data deposition in the breast milk of the development of the importance of disease, particularly its lead to epithelial hyperplasia and tumor may become relevant. 3. Explore the possible factors leading to deposition of milk and ductoscopic intervented treatment. 4. To use new examinations and treatments through ductoscopy to prevention benign diseases change to breast cancer. 5. Monitoring the development of breast cancer and doing pre-prognosis for breast cancer through ductoscopy.Methods:1. Retrospective analysis of our department from February 2003 to September 2009 totally in 20,018 cases of breast duct endoscopy results for nipple discharge of various colors, tumor in areola without nipple discharge, areola area and around the areola with plasma cell mastitis, breast cysts of deposition of milk, color Doppler echo of mammary gland prompted serious uneven and breast pain refractory to medical therapy, etc.. Severe inverted nipples and acute mastitis are contraindications. Strictly following the indications and contraindications, there is no complication. The inspections are from the papillae of patients, a small number of patients with fear reject the examinations, but those are random, and therefore does not affect the principle of a large random sample.May 2007 to September 2009 , using FVS-6000MI type endoscopic imaging systems made in Beijing Bo Laide Optical Technology Development Co., Ltd.; February 2003 to April 2007, using the FDS-3000 Fiber ductoscopy made in Japanese-developed Fujikura Ltd.. Time from February 2003 to September 2009, a total of 20,018 cases, totaling 10,082 people. In which the number of bilateral cases: 19,872 cases (9,936 people), the number of unilateral cases: 146 cases (146 times). Patients ranged in age from 12 to 84, the relative indications of all ages are different. Unmarried women as immature duct, only check the discharge hole. Under Seventies married women of patients with good organ function check more hole. for more than seventy-year-old females check appropriatelly to her health condition,.Patients from different regions of provinces and municipalities to the largest number of Jilin Province, most are outpatients, some are inpatients. Breast duct endoscopy with conventional methods and appropriate washing, check into the mirror from the main duct, the branch has been seeking all levels of the peripheral line of step by step to check the duct. Record each side of the nipple position checkpoint (1-12 point needle time) and record the depth and duct till the mirror level, take the picture. 2. Retrospective analysis of breast duct endoscopy prompted only deposition of milk with ultrasound prompted a mass formation, pathology results of 741 cases of surgical patients admitted to hospital, the main results from the pathological analysis of breast milk siltation and the relationship among milk sitation, hyperplasia and neoplasia.Results:1. Milk sitation accounts for nearly half of intraductal disease, much more than other diseases. Information through the large sample size drawn from the results confirm the milk deposition is the largest proportion in the intraductal disease, followed by ductal occlusion of inflammation, occupying lesion, duct dilation.2. Intraductal occupying lesion in patients aged mainly from 40 to 49-year-old female, followed by 30-39 years of age, the two accounted for more than 70% of duct disease. The women are married or already having babies, most are spontaneous nipple discharge ,a small number are without spontaneous nipple discharge.3. Milk deposition, occlusive duct inflammation, intraductal tumor have significant correlation in age .Milk deposition concentrated in the 30 to 39-year-old patients, occlusion of ductal inflammation concentrated in the 30 to 49-year-old patients, Intraductal occupying lesion for 40 to 49-year-old women. This indirectly reflects milk deposition has relationship with inflammation and neoplasia.4. Intraductal occupying is to combine most with milk deposition, followed by duct dilatation.5. For the patients who suffer from milk deposition causing the glands as echo disorders, and even formating clumps develop a treatment in ductoscopy by washing treatment. Nearly 92% of patients therefore avoid surgical biopsy , duct recover from being wider, while the block disappear by reducing the pressure inside the tube also the echo become the uniform. Little effect on the flushing of 8% of patients, combined with medical history and laboratory examinations to determine whether the pituitary gland, ectopic endocrine factors affecting the deposition of milk which can not be cleared.6. the patient of whom ductoscopy showed only intraductal milk deposition but ultrasonography indicated a mass formation, and have done operations in hospital with pathological examinations , the tube lesions as purely intraductal milk deposition were found mammary ductal or lobular or interstitial different degrees of proliferation, in which milk deposition with tumor-like ductal hyperplasia cover the proportion of 57.2%; milk deposition with benign or malignant breast accounted for 39.5% of the total; milk deposition with trend to malignant lesions: such as metaplasia, florid epithelial hyperplasia, epithelial hyperplasia active,fepithelial dysplasia ,the total number up to 30.7%.Conclusion:1. A large sample volume of 20,018 cases of duct microscopy results have proved the milk deposition of female breast disease accounted for the majority (42.9%), followed by ductal occlusion of inflammation, milk tube footprint, duct dilation.2 milk deposition and the happen of diseases in duct have an important correlation in ages and complications, milk deposition is closely related to the occurrence of inflammation.3 Milk deposition combined with history of pregnant and mental factor, we consider the number of artificial feeding and multiple abortions affect the nerves - endocrine impact, and the milk has a significant deposit, which could lead to the production of breast disease. But that needs further experimental evidence.4 Milk deposition can cause different degrees of duct-epithelial hyperplasia or neoplasia. The active ingredient in the milk deposition may have changed, which may accelerate epithelial hyperplasia and the risk of cancer.5 Milk deposition indicate the significance of duct endoscopy in testing duct lavage fluid of estrogen and progesterone receptor which allow us to clinically prove whether breast disease is hormone-dependent or not and to find early cancer-causing factors and use ductoscopy within drugs to treat interventionally and prevent benign disease transformate to malignant.6 Ductscopy the same time with duct lavage cytology, estrogen and progesterone receptor analysis and joint monitoring of tumor markers in early diagnosis allows us to pre-diagnosis breast cancer and monitor the development and prognosis of breast cancer.Problems:1.ductscopy have the possibility of missing, though in progress, but still can not check every duct, mainly because the special anatomic variation.2 Ductscopy has a certain incidence of complications. the progress of technology can minimize it.3 Ductoscopy or series of related inspections can only detect epithelium but stroma and lobules can not be detected, this limits the full range of diagnosis, but the value of ductscopy applications still can not be replaced by other methods .4 Ductoscopy in treatment still need further experimental studies, such as laser intensity, efficacy and possible complications and so on. |
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