目的 探讨循环肿瘤细胞（CTC）联合乳管镜影像系统提高血性乳头溢液患者恶性病变诊断效能的效果。 方法 回顾性分析2019年9月至2023年6月首都医科大学附属北京朝阳医院120例血性乳头溢液患者的临床资料，所有患者均行外周血CTC、乳管镜影像系统检查。以病理结果为金标准，判断CTC、乳管镜影像系统单独及联合检查时对血性乳头溢液患者恶性病变的诊断效能。 结果 120例患者病理结果显示良性病变88例，恶性病变32例；恶性病变组CTC计数为1（0.5，2.5）个/3.2 mL，高于良性病变组的0（0，1）个/3.2 mL（P < 0.001）；ROC曲线显示，CTC 计数诊断血性乳头溢液患者恶性病变的最佳截断值为2个/3.2 mL，共检出良性病变103例，恶性病变17例；乳管镜检查检出良性病变77例，恶性病变43例；以病理结果为金标准，CTC对血性乳头溢液患者恶性病变的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为46.88%、97.73%、84.17%、88.24%、83.50%，乳管镜检查分别为84.38%、81.82%、82.50%、62.79%、93.51%，CTC与乳管镜联合检查分别为96.88%、81.82%、85.83%、65.96%、98.63%。 结论 CTC联合乳管镜影像系统检查对血性乳头溢液患者恶性病变的诊断效能较高。

Objective To investigate the effect of circulating tumor cells （CTCS） combined with ductoscopy imaging system to improve the diagnostic efficiency of malignant lesions in patients with bloody nipple discharge. Methods Clinical data of 120 patients with bloody nipple discharge in our hospital from September 2019 to June 2023 were retrospectively analyzed， and all patients underwent peripheral blood CTC and ductoscopy. With pathological results as the gold standard， the diagnostic efficacy of CTC and ductoscopy in the diagnosis of malignant lesions in patients with bloody nipple discharge alone and in combination is evaluated. Results Pathological results of 120 patients showed benign lesions in 88 cases and malignant lesions in 32 cases. The count of CTCS in malignant lesion group was 1（0.5， 2.5）cells/3.2 mL， higher than that in benign lesion group 0（0， 1）cells/3.2 mL（P < 0.001）. ROC curve showed that the best cutoff value of CTC count for the diagnosis of malignant lesions in patients with bloody nipple discharge was 2 cells /3.2 mL. A total of 103 benign lesions and 17 malignant lesions were detected. 77 benign lesions and 43 malignant lesions were detected by ductoscopy imaging system. Using pathological results as the gold standard， the diagnostic sensitivity， specificity， accuracy， positive predictive value and negative predictive value of CTC for malignant lesions in patients with bloody nipple discharge were 46.88%， 97.73%， 84.17%， 88.24% and 83.50%， respectively. 84.38%， 81.82%， 82.50%， 62.79%， 93.51% for ductoscopy， and 96.88%， 81.82%， 85.83%， 65.96%， 98.63% for CTC combined with ductoscopy. Conclusion The diagnosis of malignant lesions in patients with bloody nipple discharge by CTC combined with ductoscopic imaging system is more effective.