Meme Başı Akıntısı ve Mastaljide Yaklaşım
Özet
Meme başı akıntısı ve mastalji, polikliniklerde sık karşılaşılan, ayrıntılı anamnez, fizik muayene ve yaşa göre ultrasonografi (US) veya mamografi (MMG) ile değerlendirilen yaygın klinik şikayetlerdir. Meme başı akıntıları patolojik (spontan, tek taraflı, kanlı veya kitle eşlik eden) ve fizyolojik (bilateral, çok kanallı) olarak ikiye ayrılır; fizyolojik durumlarda TSH ve prolaktin düzeyleri incelenirken, patolojik durumlarda ileri görüntüleme (MRG, duktografi) ve duktus eksizyonu gibi cerrahi yaklaşımlar gerekebilir. Kadınların %70’inde görülen mastalji ise döngüsel (hormonal), döngüsel olmayan ve meme dışı kaynaklı olmak üzere üç grupta ele alınır. Unilateral ve fokal ağrılarda kanser şüphesini dışlamak adına görüntüleme istenirken, yaygın ve iki taraflı ağrılarda genellikle klinik güvence yeterlidir. Yaşam kalitesini etkileyen mastalji vakalarında fiziksel destek, topikal/oral NSAİİ'ler ilk basamakta; dirençli olgularda ise tamoksifen veya danazol gibi hormonal ajanlar ikinci basamakta tercih edilmektedir.
Nipple discharge and mastalgia are common clinical complaints frequently encountered in outpatient clinics, evaluated through detailed medical history, physical examination, and age-appropriate ultrasonography (US) or mammography (MMG). Nipple discharges are categorized into pathological (spontaneous, unilateral, bloody, or associated with a mass) and physiological (bilateral, multi-ductal); while TSH and prolactin levels are investigated in physiological cases, advanced imaging (MRI, ductography) and surgical approaches like duct excision may be required in pathological conditions. Mastalgia, affecting 70% of women, is classified into cyclical (hormonal), non-cyclical, and extramammary types. Imaging is recommended for unilateral and focal pain to rule out malignancy, whereas clinical reassurance is generally sufficient for diffuse and bilateral pain. In mastalgia cases impairing the quality of life, physical support and topical/oral NSAIDs are preferred in the first-line treatment, while hormonal agents like tamoxifen or danazol are utilized as second-line therapy for resistant cases.
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