Breast ductography
Updates to Article Attributes
Breast ductography (also known as galactography) is an imaging technique which is used to evaluate lesions causing nipple discharge. It helps in precisely locating the mass within breast tissue and gives useful information for surgical approach and planning.
Technique
A blunt-tipped sialogram needle (30-gauge) is used for performing ductogram. The abnormal duct is identified and cannulated. Approximately 1-2 ml of contrast is injected. A standard two view mammography (or CC and ML projections) are obtained.
Indications
There is significant confusion generally about when ductography is indicated. The primary indication is to evaluate a single duct which has a discharge. In cases where there are multiple discharging ducts or bilateral discharge, ductography is not indicated because the etiology is systemic or physiological.
Procedure
The procedure takes patience and perseverance to perform successfully. This is generally not a painful procedure although patienst are understandably apprehensive. The duct is identified by asking the patient to express the discharge. The radiologist uses a good light and magnifier to perform the procedure which is aseptic. The contrast material injected into the duct can be mixed with methylene blue for preoperative asessment and localization to aid the surgeon to locate the offending duct. In practice, if you are having trouble seeing the duct opening, use a single drop of contrast from the catheter as a small drop magnifier on the skin. This works very well. Try not to traumatise the duct opening in the process of catheterization.
Surgery
The majority of the lesions found in ducts are duct papillomas. Current practice holds that these lesions should be excised to exclude a malignant lesion. If the duct lesion is large enough, ultrasound guided percutaneous biopsy can make the diagnosis of a papilloma quite successfully. The duct is excised after it is filled with dye.
Radiographic assessment
Most of the intraductal abnormalities on mammography is identified as form of filling defects. These can occur from both true pathological and artifactual (e.g. air bubble) causes. Other abnormal patterns include:
- fusiform or tubular dilatation of ducts: occurs with mammary duct ectasia
- abrupt ductal cut off: can occur with an obstructive distal lesion
Complications
- duct perforation, which may lead to extravasation of contrast into breast parenchyma
- pain or a burning sensation
- infection: galactography should not be performed when there is a purulent breast discharge
See also
-<p><strong>Breast ductography</strong> (also known as <strong>galactography</strong>) is an imaging technique which is used to evaluate lesions causing nipple discharge. It helps in precisely locating the mass within breast tissue and gives useful information for surgical approach and planning.</p><h4>Technique</h4><p>A blunt-tipped sialogram needle (30-gauge) is used for performing ductogram. The abnormal duct is identified and cannulated. Approximately 1-2 ml of contrast is injected. A standard two view mammography (or CC and ML projections) are obtained.</p><h4>Indications</h4><p>There is significant confusion generally about when ductography is indicated. The primary indication is to evaluate a single duct which has a discharge. In cases where there are multiple discharging ducts or bilateral discharge, ductography is not indicated because the etiology is systemic or physiological.</p><h4>Procedure</h4><p>The procedure takes patience and perseverance to perform successfully. This is generally not a painful procedure although patienst are understandably apprehensive. The duct is identified by asking the patient to express the discharge. The radiologist uses a good light and magnifier to perform the procedure which is aseptic. The contrast material injected into the duct can be mixed with methylene blue for preoperative asessment and localization to aid the surgeon to locate the offending duct. In practice, if you are having trouble seeing the duct opening, use a single drop of contrast from the catheter as a small drop magnifier on the skin. This works very well. Try not to traumatise the duct opening in the process of catheterization.</p><h4>Surgery</h4><p>The majority of the lesions found in ducts are duct papillomas. Current practice holds that these lesions should be excised to exclude a malignant lesion. If the duct lesion is large enough, ultrasound guided percutaneous biopsy can make the diagnosis of a papilloma quite successfully. The duct is excised after it is filled with dye.</p><h4>Radiographic assessment</h4><p>Most of the intraductal abnormalities on mammography is identified as form of filling defects. These can occur from both true pathological and artifactual (e.g. air bubble) causes. Other abnormal patterns include</p><ul>- +<p><strong>Breast ductography</strong> (also known as <strong>galactography</strong>) is an imaging technique which is used to evaluate lesions causing nipple discharge. It helps in precisely locating the mass within breast tissue and gives useful information for surgical approach and planning.</p><h4>Technique</h4><p>A blunt-tipped sialogram needle (30-gauge) is used for performing ductogram. The abnormal duct is identified and cannulated. Approximately 1-2 ml of contrast is injected. A standard two view mammography (or CC and ML projections) are obtained.</p><h4>Indications</h4><p>There is significant confusion generally about when ductography is indicated. The primary indication is to evaluate a single duct which has a discharge. In cases where there are multiple discharging ducts or bilateral discharge, ductography is not indicated because the etiology is systemic or physiological.</p><h4>Procedure</h4><p>The procedure takes patience and perseverance to perform successfully. This is generally not a painful procedure although patienst are understandably apprehensive. The duct is identified by asking the patient to express the discharge. The radiologist uses a good light and magnifier to perform the procedure which is aseptic. The contrast material injected into the duct can be mixed with methylene blue for preoperative asessment and localization to aid the surgeon to locate the offending duct. In practice, if you are having trouble seeing the duct opening, use a single drop of contrast from the catheter as a small drop magnifier on the skin. This works very well. Try not to traumatise the duct opening in the process of catheterization.</p><h4>Surgery</h4><p>The majority of the lesions found in ducts are duct papillomas. Current practice holds that these lesions should be excised to exclude a malignant lesion. If the duct lesion is large enough, ultrasound guided percutaneous biopsy can make the diagnosis of a papilloma quite successfully. The duct is excised after it is filled with dye.</p><h4>Radiographic assessment</h4><p>Most of the intraductal abnormalities on mammography is identified as form of filling defects. These can occur from both true pathological and artifactual (e.g. air bubble) causes. Other abnormal patterns include:</p><ul>
-<li>infection : galactography should not be performed when there is a purulent breast discharge</li>- +<li>infection: galactography should not be performed when there is a purulent breast discharge</li>
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