The Clinical Survey Of The Diagnosis And Treatment Of Intraductal Papillary Lesions

Background:Intraductal papillary lesions are a kind of diseases that characterized by papillary structures formed by fibrovascular axis surrounding by epithelium,with or without myoepithelial cells.Patients always consult a doctor for nipple discharge or breast masses.Since papillary lesions include benign and malignant lesions and the management and prognosis of each papillary lesion is different,it is important to diagnose these lesions exactly.However,it is different in clinical manifestation and histopathology for its various clinical features and histopathology,which results in challenges to clinic and pathological doctors.There are many kinds of examinations.Since the intraoperative frozen pathology appeared to guide the intraoperative operation methods of breast diseases,it has been necessary.Objective:To study the risk factors of malignant intraductal papillary lesions and the differential diagnosis of benign and malignant intraductal papillary lesions and the value of intraoperative frozen pathology in diagnosis and treatment of intraductal papillary lesions.Methods:A total of 1165 patients of Qilu hospital with postoperative pathological examination of intraductal papillary lesions,from Jan.2010 to Sept.2016,is retrospectively analyzed.Results:1.The constituent ratio of intraductal papillary lesions:1169 patients with intraductal papillary lesions accounted for 10.51%of mammary diseases,and malignant papillary lesions accounted for 1.35%.2.The clinical manifestation and accessory examination:the nipple discharge(41.20%)was the main clinical manifestation of benign papillary lesions,when the breast masses(63.83%)was the main clinical manifestation of malignant papillary lesions.Ultrasound was the most sensitive method and the mammograms help to judge their nature.When the lesions presented nipple discharge and cytoloinagical examtion of nipple discharge was performed,the false positive rate was 5.67%,which proved that the cytological examination could not be the pathological diagnostic criteria.3.The risk factors of malignant intraductal papillary lesions:There was statistic difference of age between different groups(p<0.05),which suggested that the age was one risk factor of malignant intraductal papillary lesions,as well as menarche age,menstrual cycle,pregnancy and production time(p<0.05),related to the change of female endocrine function.The difference also existed in the history of smoking,diabetes,and hypertension(p<0.05),which suggested that the environment and metabolic changes were risk factors of malignant intraductal papillary lesions.4.The differential diagnosis of benign and malignant intraductal papillary lesions:Clinical manifestation,the mammogram changes,and nipple discharge presenting single duct,bloody and the rise in tumor markers in nipple discharge were significant to diagnose benign and malignant intraductal papillary lesions.5.The value of intraoperative frozen pathology:There were 851 cases(66.64%)can be diagnosed exactly,when there were 147 cases(11.51%)was diagnosed as intraductal papillary neoplasm.There were 279 cases(21.85%)was diagnosed inexactly,in which,79 cases(28.32%)leveled up,178 cases had the same grade and 22 cases(7.89%)leveled down.There were 20 cases that performed second surgery.6.The clinical features of encapsulated papillary carcinoma and solid papillary carcinoma:Compared with intraductal papillary carcinoma,there were differences on age,nipple discharge,menopause,menstrual cycle history of diabetes and hypertension,when there were less differences between encapsulated papillary carcinoma and solid papillary carcinoma with and without invasive composition.Conclusions:The main clinical manifestation of the intraductal papillary lesions was nipple discharge and mammary masses.Breast ultrasound,mammography is of value to diagnose intraductal papillary lesions.The age,menarche age,menstrual cycle,pregnancy and production time,related to the change of female endocrine function,the environment and metabolic changes were risk factors of malignant intraductal papillary lesions.Clinical manifestation,the mammogram changes,and nipple discharge presenting single duct,bloody and the rise in tumor markers in nipple discharge were significant to diagnose benign and malignant intraductal papillary lesions.Although the intraoperative frozen pathology is of value to diagnose intraductal papillary lesions and guide the surgery means,the misdiagnosis and the delay of diagnosis existed,which may lead to the second surgery.So,the exact diagnosis is on the basis of postoperative paraffin pathology and immunohistochemical staining sometimes.The encapsulated papillary carcinoma and solid papillary carcinoma had different clinical features from intraductal papillary carcinoma.