乳腺导管扩张症术前误诊原因分析（Misdiagnosis of mammary duct ectasia before operation）

乳腺导管扩张症术前误诊原因分析（Misdiagnosis of mammary duct ectasia before operation） 乳腺导管扩张症术前误诊原因分析(Misdiagnosis of mammary duct ectasia before operation) Misdiagnosis of mammary duct ectasia before operation Update Date: 09-13 Zhang Jingxue Keywords breast disease / diagnosis; mammary duct ectasia / diagnosis; Misdiagnosis; breast neoplasms / diagnosis; Key, words, Breast, diseases/diagnosis, Breast, duct, ectacsis/diagnosis, Diagnostic,, errors, Breast, neoplasms/diagnosis Mammary duct ectasia has a wide variety of diseases. In 1963, the name was identified by Haargensen for the first time. The incidence rate is about 4.5% [1] of benign breast diseases. Because the etiology of this disease is uncertain and the signs are various, it should be carefully identified in breast diseases such as breast cancer, intraductal papilloma and so on in order to reduce the incidence of misdiagnosis and missed diagnosis. Our hospital from October 1986 to October 1996, preoperative misdiagnosis and missed diagnosis of mammary duct ectasia in 19 cases, is the cause of misdiagnosis of a preliminary analysis. 1 clinical information 1.1 general data 19 cases were female, the average age was 42.3 years old, including 33~40 years old 12 cases (63.2%), the course of disease is 14 days to 7 years, average 10 months. 19 cases were not lactating women after the birth, 6 cases had acute mastitis (31.5%), 9 cases (47.1%) were not breast-feeding and breast-feeding for six months. 15 cases of 1.2 signs of breast lumps treatment, 8 cases of tumors located in the deep areola, distributed in 7 cases of breast lumps in each quadrant; the minimum volume of 1 cm * 1 cm * 0.8 cm, a maximum of 5 cm * 5cm * 6 cm; mass tenderness in 9 cases (60%). There were 4 cases with milk overflow, including 2 cases of bloody discharge, 1 cases of yellow overflow and purulent discharge. Nipple in 4 cases, the skin is orange dermoid changes in 2 cases, areola place in eczemamodel change in 1 cases. There were 4 cases with axillary lymph node enlargement and tenderness in the affected side. 6 cases had been treated with antibiotics, of which 4 cases had reduced or diminished symptoms, and the effective rate of anti infection was 66.6%. 4 cases of the 1.3 auxiliary examination of this group of breast biopsy, diagnosis of breast adenoma; fine needle aspiration cytology in 2 cases, the initial impression of breast inflammation; nipple discharge smear cytology in 4 cases, showing a large number of red blood cells, inflammatory cells and foam cells; the remaining 9 cases only by palpation highly suspected of breast cancer. 1.4 misdiagnosed diseases were misdiagnosed as 9 cases of breast cancer, 5 cases of intraductal papilloma, 3 cases of breast hyperplasia, and 2 cases of breast fibroma. All the 19 cases were proved to be mammary duct ectasia after operation. 2 discussion 2.1, the average age of onset in this group is 42.3 years. The average age of breast cancer is about 10 years earlier, which is consistent with the literature report. [2]. The data also show that the majority of patients are non lactating women after birth, and the course of disease is more than 1 years. Its pathogenesis may be related to the disorders of lactation, endocrine dysfunction and breast degeneration. There were 15 cases of breast diseases due to various reasons, among which 2 cases were caused by endocrine disorders, 1 cases had hyperthyroidism, and 1 cases underwent removal of uterus and accessories because of ovarian diseases. 2 cases of degenerative breast disease were women after amenorrhea. 2.2 the cause of misdiagnosis is relatively difficult because of the difference in the history, symptoms and signs of the disease. In this group 19 cases, 1 cases were diagnosed accurately before operation, which may be related to the following reasons: first, the disease occurred in middle-aged women, and most of them were treated with painless breast lumps. The longer course, because fiber tissue surrounding the ductal hyperplasia and inflammatory reaction, leading to ductal shortening and skin shrinkage, and nipple skin and orange dermoid change; because breast lumps or other signs of breast cancer and similar to the clinical misdiagnosed as breast cancer. The affected side is often accompanied by axillary lymph node enlargement, and clinicians routinely judge axillary lymph node metastasis of breast cancer. There are 4 cases in this article. Nipple discharge may be the only symptom of this disease at the early stage. Such as bloody discharge, sometimes difficult to identify intraductal papilloma and breast cancer and other diseases. Two 3 diagnostic experience for breast disease patients over the age of 40, non lactation or menopausal women, especially in the history of breast-feeding disorders, must be aware of the possibility of mammary duct ectasia. Patients with breast lumps to see a doctor, palpation, such as found in the depth of the areola, and the boundary of the regular, surface is not smooth or accompanied by tenderness, axillary lymph nodes often tenderness, it is possible to think of this disease. Those who have nipple discharge should be examined by smear cytology when they have condition. If there is no nipple discharge, they can be gently squeezed during the examination to see if there is any overflow of mammary secretions. When the diagnosis of breast lumps is difficult, feasible breast needle aspiration cytology is necessary. At present some scholars think that the breast examination methods such as thermal image, near infrared scan and B-mode ultrasound have no specific diagnostic value for mammary duct ectasia, but they still have some significance for differential diagnosis. When conditions permit, a feasible mammary duct examination is performed, except for intraductal papilloma. Different types of mammary duct ectasia have different treatment methods, and the most common tumor types still have surgical resection. For patients with breast masses or highly suspicious breast cancer before surgery, surgical exploration should be considered, and rapid intraoperative frozen section examination should be performed to make a definite diagnosis. Beijing He Ping Li Hospital, [100013] Reference [1] Cao Yuemin, Wang Guopei. Breast surgery. First edition. Shijiazhuang: Hebei science and Technology Press, 1991:142 [2] Zhang crystal. Breast cancer. First edition. Shanghai: Shanghai science and Technology Press, 1990:178