Zusammenfassung
Fragestellung: Ist die selektive Duktektomie nach duktoskopischer Drahtmarkierung bei pathologischer
Mamillensekretion sicher durchführbar? Stellt die Methode eine sinnvolle Alternative
zur Reduktion des Resektionsvolumens zur Duktektomie nach Urban dar? Material und Methode: Bei 45 Patientinnen, mittleres Alter 52 Jahre (Range 21–71), wurde wegen einer pathologischen
Sekretion eine selektive Duktektomie durchgeführt. Dazu wurden Duktoskope von 0,9
und 1,1 mm Durchmesser eingesetzt. Es wurden nur Patientinnen eingeschlossen, die
sonografisch und mammografisch kein Korrelat für die Sekretion zeigten. Der pathologische
Milchgang wurde duktoskopisch über einen Arbeitskanal drahtmarkiert und extirpiert.
Die histologischen Ergebnisse wurden mit der Zytologie, Galaktografie und Duktoskopie
verglichen. Ergebnisse: In 32 von 45 Fällen (71 %) wurde histologisch eine intraduktale, epitheliale Proliferation
gefunden. Folgende Sensitivitäten konnten ermittelt werden: Zytologie 12 %, Galaktografie
70 %, Duktoskopie 79 %. Schlussfolgerung: Die Methode erlaubt eine selektive Duktektomie unter direkter Visualisierung des
Milchgangs und der intraduktalen Proliferation. Subjektiv lässt sich damit das Resektionsvolumen
gegenüber der unselektiven Duktektomie reduzieren.
Abstract
Purpose: Aim of the study was to investigate the diagnostic reliability of selective microdochectomy
after direct ductoscopic wire marking of suspect lesions in patients with pathological
nipple discharge. Material and Methods: Selective microdochectomy due to pathological discharge was performed in 45 patients
with a mean age of 52 years (range 21–71). Ductoscopes with diameters of 0.9 and 1.1
mm and a channel for wire marking were used. Only patients without sonographic or
mammographic correlation for the discharge were included. The pathologic mammary duct
was wire marked and extirpated under direct visual guidance via the ductoscope. The
histological results were compared with cytology, galactography and ductoscopy. Results: In 32 of 45 cases (71 %) an intraductal, epithelial proliferation was found histologically.
The following sensitivities for intraductal, epithelial proliferations could be determined:
cytology 12 %, galactography 70 %, and ductoscopy 79 %. Conclusion: The method allows selective microdochectomy of the pathological duct and intraductal
proliferation to be performed under visual guidance. The resection volume can be reduced
in contrast to unselective ductectomy after injection of methylene blue.
Schlüsselwörter
pathologische Mamillensekretion - Duktoskopie - Duktektomie - Galaktografie - Mammadiagnostik
Key words
pathological nipple discharge - ductoscopy - microdochectomy - galactography
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Dr. Markus Hahn
Universitäts-Frauenklinik Tübingen
Calwerstraße 7
72076 Tübingen
Email: markus.hahn@med.uni-tuebingen.de