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Breast
Procedures
Image-Guided Procedures
Ductography
Ductography
Haydee Ojeda-Fournier, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Synonyms

            • Galactography, ductogram

          • Definitions

            • Contrast radiographic examination of mammary ducts performed to identify intraductal lesion(s) in patients with suspicious nipple discharge
              • Once significant lesion identified
                • Image-guided biopsy, duct excision ± preoperative localization
                • If clinically suspicious discharge but negative imaging work-up (including ductogram and MR), patient may undergo major duct excision or ductoscopy

          PREPROCEDURE

          • Indications

            • Contraindications

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Equipment Preparation

                    • Procedure Steps

                      • Findings and Reporting

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Expected Outcome

                            • Things to Do

                              • Things to Avoid

                                OUTCOMES

                                • Complications

                                  • Pitfalls

                                    Selected References

                                    1. Bahl M et al: Journal Club: Diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge. AJR Am J Roentgenol. 209(6):1404-1410, 2017
                                    2. Berger N et al: Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: A systematic review and meta-analysis. AJR Am J Roentgenol. 209(2):465-471, 2017
                                    3. Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria® Evaluation of Nipple Discharge. J Am Coll Radiol. 14(5S):S138-S153, 2017
                                    4. Bahl M et al: Reply to "conventional ductography combined with digital breast tomosynthesis for imaging of pathologic nipple discharge". AJR Am J Roentgenol. 206(2):W45, 2016
                                    5. Cohen Y: Conventional ductography combined with digital breast tomosynthesis for imaging of pathologic nipple discharge. AJR Am J Roentgenol. 206(2):W44, 2016
                                    6. Sheiman LS et al: The in's and out's of ductography: A comprehensive review. Curr Probl Diagn Radiol. 45(1):61-70, 2016
                                    7. Bahl M et al: Diagnostic value of ultrasound in female patients with nipple discharge. AJR Am J Roentgenol. 205(1):203-8, 2015
                                    8. Bahl M et al: Evaluation of pathologic nipple discharge: What is the added diagnostic value of MRI? Ann Surg Oncol. 22 Suppl 3:S435-41, 2015
                                    9. Nicholson BT et al: 3D-MR ductography and contrast-enhanced MR mammography in patients with suspicious nipple discharge; a feasibility study. Breast J. 21(4):352-62, 2015
                                    10. Aslam MO et al: Technical innovation: wire guided ductography. Eur J Radiol. 81(7):1543-5, 2012
                                    11. Morrogh M et al: Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg. 200:73-80, 2010
                                    12. Woodward S et al: Ensuring excision of intraductal lesions: marker placement at time of ductography. Acad Radiol. 17(11):1444-8, 2010
                                    13. Carvalho MJ et al: What is the diagnostic value of nipple discharge cytology and galactography in detecting duct pathology? Eur J Gynaecol Oncol. 30(5):543-6, 2009
                                    14. Kim SH et al: Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis. Arch Gynecol Obstet. 280(2):217-22, 2009
                                    15. Reiner CS et al: Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy? Eur Radiol. 19(12):2878-85, 2009
                                    16. Berná-Serna JD et al: Galactography without discomfort using lidocaine/prilocaine anesthetic cream. Acta Radiol. 49(1):22-4, 2008
                                    17. Schwab SA et al: Direct MR galactography: feasibility study. Radiology. 249(1):54-61, 2008
                                    18. Morrogh M et al: The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 14(12):3369-77, 2007
                                    19. Rissanen T et al: Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. J Ultrasound Med. 26(8):1031-9, 2007
                                    20. Bhattarai N et al: Intraductal papilloma: features on MR ductography using a microscopic coil. AJR Am J Roentgenol. 186(1):44-7, 2006
                                    21. Cho N et al: Ductographic findings of breast cancer. Korean J Radiol. 6(1):31-6, 2005
                                    22. Greenberg D et al: Ductography: a pictorial essay of common pathologies. Breast J. 10(5):454-7, 2004
                                    23. Sakorafas GH: Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 27(5):275-82, 2001
                                    24. Slawson SH et al: Ductography: how to and what if? Radiographics. 21(1):133-50, 2001
                                    25. Dawes LG et al: Ductography for nipple discharge: no replacement for ductal excision. Surgery. 124(4):685-91, 1998
                                    26. Hild F et al: Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev. 7 Suppl 1:S57-62, 1998
                                    27. Cardenosa G et al: Ductography of the breast: technique and findings. AJR Am J Roentgenol. 162(5):1081-7, 1994
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Preprocedure

                                        • Procedure

                                          • Outcomes

                                            TERMINOLOGY

                                            • Synonyms

                                              • Galactography, ductogram

                                            • Definitions

                                              • Contrast radiographic examination of mammary ducts performed to identify intraductal lesion(s) in patients with suspicious nipple discharge
                                                • Once significant lesion identified
                                                  • Image-guided biopsy, duct excision ± preoperative localization
                                                  • If clinically suspicious discharge but negative imaging work-up (including ductogram and MR), patient may undergo major duct excision or ductoscopy

                                            PREPROCEDURE

                                            • Indications

                                              • Contraindications

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Equipment Preparation

                                                      • Procedure Steps

                                                        • Findings and Reporting

                                                          • Alternative Procedures/Therapies

                                                            POST PROCEDURE

                                                            • Expected Outcome

                                                              • Things to Do

                                                                • Things to Avoid

                                                                  OUTCOMES

                                                                  • Complications

                                                                    • Pitfalls

                                                                      Selected References

                                                                      1. Bahl M et al: Journal Club: Diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge. AJR Am J Roentgenol. 209(6):1404-1410, 2017
                                                                      2. Berger N et al: Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: A systematic review and meta-analysis. AJR Am J Roentgenol. 209(2):465-471, 2017
                                                                      3. Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria® Evaluation of Nipple Discharge. J Am Coll Radiol. 14(5S):S138-S153, 2017
                                                                      4. Bahl M et al: Reply to "conventional ductography combined with digital breast tomosynthesis for imaging of pathologic nipple discharge". AJR Am J Roentgenol. 206(2):W45, 2016
                                                                      5. Cohen Y: Conventional ductography combined with digital breast tomosynthesis for imaging of pathologic nipple discharge. AJR Am J Roentgenol. 206(2):W44, 2016
                                                                      6. Sheiman LS et al: The in's and out's of ductography: A comprehensive review. Curr Probl Diagn Radiol. 45(1):61-70, 2016
                                                                      7. Bahl M et al: Diagnostic value of ultrasound in female patients with nipple discharge. AJR Am J Roentgenol. 205(1):203-8, 2015
                                                                      8. Bahl M et al: Evaluation of pathologic nipple discharge: What is the added diagnostic value of MRI? Ann Surg Oncol. 22 Suppl 3:S435-41, 2015
                                                                      9. Nicholson BT et al: 3D-MR ductography and contrast-enhanced MR mammography in patients with suspicious nipple discharge; a feasibility study. Breast J. 21(4):352-62, 2015
                                                                      10. Aslam MO et al: Technical innovation: wire guided ductography. Eur J Radiol. 81(7):1543-5, 2012
                                                                      11. Morrogh M et al: Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg. 200:73-80, 2010
                                                                      12. Woodward S et al: Ensuring excision of intraductal lesions: marker placement at time of ductography. Acad Radiol. 17(11):1444-8, 2010
                                                                      13. Carvalho MJ et al: What is the diagnostic value of nipple discharge cytology and galactography in detecting duct pathology? Eur J Gynaecol Oncol. 30(5):543-6, 2009
                                                                      14. Kim SH et al: Galactography acquired with digital mammography in patients with nipple discharge: a retrospective analysis. Arch Gynecol Obstet. 280(2):217-22, 2009
                                                                      15. Reiner CS et al: Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy? Eur Radiol. 19(12):2878-85, 2009
                                                                      16. Berná-Serna JD et al: Galactography without discomfort using lidocaine/prilocaine anesthetic cream. Acta Radiol. 49(1):22-4, 2008
                                                                      17. Schwab SA et al: Direct MR galactography: feasibility study. Radiology. 249(1):54-61, 2008
                                                                      18. Morrogh M et al: The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol. 14(12):3369-77, 2007
                                                                      19. Rissanen T et al: Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients. J Ultrasound Med. 26(8):1031-9, 2007
                                                                      20. Bhattarai N et al: Intraductal papilloma: features on MR ductography using a microscopic coil. AJR Am J Roentgenol. 186(1):44-7, 2006
                                                                      21. Cho N et al: Ductographic findings of breast cancer. Korean J Radiol. 6(1):31-6, 2005
                                                                      22. Greenberg D et al: Ductography: a pictorial essay of common pathologies. Breast J. 10(5):454-7, 2004
                                                                      23. Sakorafas GH: Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 27(5):275-82, 2001
                                                                      24. Slawson SH et al: Ductography: how to and what if? Radiographics. 21(1):133-50, 2001
                                                                      25. Dawes LG et al: Ductography for nipple discharge: no replacement for ductal excision. Surgery. 124(4):685-91, 1998
                                                                      26. Hild F et al: Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev. 7 Suppl 1:S57-62, 1998
                                                                      27. Cardenosa G et al: Ductography of the breast: technique and findings. AJR Am J Roentgenol. 162(5):1081-7, 1994