摘要 目的 探讨乳管镜联合美蓝染色定位法在病理性乳头溢液患者诊疗中的应用价值。 方法 收集2010年1月—2016年5月于我科行乳管镜检查的病理性乳头溢液患者421例，病变导管内注射美蓝染色定位，次日行病变导管及区段切除，分析乳管镜联合美蓝染色定位法与病理检查结果之间的相关性。 结果 乳管镜联合美蓝染色发现导管内见隆起性病变或新生物者341例，占80.99%，其中主要为导管内占位性病变299例；80例导管内未见隆起性病变或新生物中，终末导管开口处有暗红色血性液溢出6例，终末导管开口处有黄色浆液性液溢出5例，广泛糜烂灶4例，终末导管开口处广泛絮状物及纤维网63例，乳腺导管开口处导管扩张及脓液2例。乳管镜联合美蓝染色定位法诊断乳腺癌的灵敏度为58.54%，特异度为98.95%，阳性预测值为85.71%，阴性预测值为95.67%。 结论 乳管镜联合美蓝染色定位法简单易行，对乳头溢液患者进行早期乳腺癌的筛查具有一定的意义。同时该定位法可降低术中因切除范围不准确而漏诊乳腺癌。 Abstract：Objective To investigate the clinical value of ductoscopy combined with methylene blue staining for localization in the diagnosis and treatment of patients with pathological nipple discharge. Methods A total of 421 patients with pathological nipple discharge who underwent ductoscopy in our department from January 2010 to May 2016 were enrolled. Methylene blue was injected into the lesions for localization, and the lesions and related segments were resected on the next day. The association between methylene blue staining results and pathological examination results was analyzed. Results Of all 421 patients, 341 (80.99%) were found to have bulging lesions or neoplasms in the duct by ductoscopy combined with methylene blue staining, among whom 299 had intraductal space-occupying lesions; 80 did not have bulging lesions or neoplasms in the duct, among whom 6 had dark-red bloody liquid discharge at the end of the terminal catheter, 5 had yellow serous liquid discharge at the end of the terminal catheter, 4 had extensive erosion, 63 had extensive flocculation and fiber web at the end of the terminal catheter, and 2 had dilatation and pus in the opening of the breast duct. Ductoscopy combined with methylene blue staining for localization had a sensitivity of 58.54%, a specificity of 98.95%, a positive predictive value of 85.71%, and a negative predictive value of 95.67% in the diagnosis of breast cancer. Conclusion Ductoscopy combined with methylene blue staining for localization is simple and easy and has a certain value in the screening for early-stage breast cancer in patients with nipple discharge. Meanwhile, it can reduce missed diagnosis of breast cancer due to inaccurate resection extent
