探讨超声与纤维乳管镜对病理性乳头溢液患者的诊断价值。

回顾性分析2013年9月至2019年5月在浙江大学医学院附属杭州市第一人民医院就诊、完成超声和纤维乳管镜检查的病理性乳头溢液患者426例，共430个乳房。以病理及临床诊断为金标准，应用四格表计算超声、纤维乳管镜及联合方法对乳腺导管内病变的诊断效能。

430个乳房中，乳腺导管内病变病理结果阳性187个，病理及临床诊断结果阴性243个。纤维乳管镜的诊断敏感度、准确性及阴性预测值均高于超声（86.10% vs 61.50%、82.09% vs 78.14%、88.07% vs 74.43%），超声的诊断特异度和阳性预测值高于纤维乳管镜（90.95% vs 79.01%、83.94% vs 75.94%）。超声联合纤维乳管镜（其中任一检查结果为阳性，即判定为阳性）的诊断敏感度、特异度、阳性预测值、阴性预测值和准确性分别为100%、95.88%、94.92%、100%、97.67%，均高于单一检查方法的诊断效能。

超声联合纤维乳管镜对病理性乳头溢液患者具有较好的诊断价值，可为病理性乳头溢液患者的临床管理和随访提供依据。

To explore the diagnostic value of ultrasound and fiberoptic ductoscopy in patients with pathological nipple discharge.

A retrospective analysis was performed on 426 patients (a total of 430 breasts) with pathological nipple discharge who completed ultrasound and fiberoptic ductoscopy at Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine from September 2013 to May 2019. Taking pathological and clinical diagnosis as the gold standard, the four-grid table was used to calculate the diagnostic efficacy of ultrasound, fiberoptic ductoscopy, and their combination for breast ductal lesions.

Among 430 breasts, 187 were positive for breast ductal lesions and 243 were negative. The diagnostic sensitivity, accuracy, and negative predictive value of fiberoptic ductoscopy were higher than those of ultrasound (86.10% vs 61.50%, 82.09% vs 78.14%, and 88.07% vs 74.43%, respectively), and the diagnostic specificity and positive predictive value of ultrasound were higher than those of fiberoptic ductoscopy (90.95% vs 79.01% and 83.94% vs 75.94%, respectively). The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound combined with fiberoptic ductoscopy (when any one of which was positive, it would be judged as positive) were 100%, 95.88%, 94.92%, 100%, and 97.67%, respectively, which were higher than those of either of them.

Ultrasound combined with fiberoptic ductoscopy has good diagnostic value for patients with pathological nipple discharge, and can provide evidence for their clinical management and follow-up.