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Open Access 01-12-2023 | Mammography | Educational Review

Breast ductography: to do or not to do? A pictorial essay

Authors: Afsaneh Alikhassi, Belinda Curpen

Published in: Insights into Imaging | Issue 1/2023

Abstract

Nipple discharge is a frequent breast disease clinical presentation. Although most cases of nipple discharge are physiologic, pathologic nipple discharge is not uncommon. Eight to 15% of pathological nipple discharge is associated with malignancy, requiring investigation. Some specialists believe that ductography is a challenging procedure that is better to be substituted by other methods, such as MRI. However, an experienced physician can perform ductography quickly and easily and still play an essential role in some clinical scenarios. Conventional imaging, such as mammography and sonography, commonly fails to detect the underlying causes of pathological nipple discharge. MRI has limitations of low specificity, cost, lengthy exam duration, accessibility, and patient factors such as claustrophobia. In addition, we can make a specific diagnosis and appropriate treatment by coupling ductography with other methods, such as ultrasound-guided or stereotactic biopsy. This study aims to present the ductography technique, possible findings, and the clinical settings where ductography is useful.

Critical relevance statement Although ductography is currently less used in breast imaging, it still plays an essential role in some clinical scenarios. These clinical scenarios include pathological nipple discharge with negative conventional imaging, contraindicated MRI, unavailable MRI, unremarkable MRI results, and multiple MRI findings.

Key points

• Conventional imaging commonly fails to detect the underlying causes of pathological nipple discharge.

• MRI in the setting of nipple discharge has some limitations.

• Ductography still plays an essential role in some clinical scenarios.

• Coupling ductography with other methods helps make a specific diagnosis.

Graphical Abstract

Yamamoto D, Shoji T, Kawanishi H, et al. (2001) A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge. Breast Cancer Res Treat 70(2):103–8. https://doi.org/10.1023/a:1012990809466. (PMID: 11768599)CrossRefPubMed

Hirose Masanori, Nobusawa Hiroshi, Gokan Takehiko (2007) MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics 27(suppl_1):S183–S196CrossRefPubMed

Hussain AN, Policarpio C, Vincent MT (2006) Evaluating nipple discharge. Obstet Gynecol Surv 61:278–283CrossRefPubMed

Sauter ER, Schlatter L, Lininger J, Hewett JE (2004) The association of bloody nipple discharge with breast pathology. Surgery 136:780–785CrossRefPubMed

Nicholson BT, Harvey JA, Patrie JT, Mugler JP III (2015), 3D-MR ductography and contrast-enhanced MR mammography in patients with suspicious nipple discharge; a feasibility study. Breast J 21(352):362. https://doi.org/10.1111/tbj.12417CrossRef

Cho N, Moon WK, Chung SY, et al. (2005) Ductographic findings of breast cancer. Korean J Radiol 6(1):31–36CrossRefPubMedPubMedCentral

Stavros AT (2004) Nontargeted indications: breast secretions, nipple discharge, and intraductal papillary lesions of the breast. In: Stavros AT (ed) Breast ultrasound, 1st edn. Lippincott Williams & Wilkins, Philadelphia, pp 157–198

Chung SY, Lee KW, Park KS, Lee Y, Bae SH (1995) Breast tumors associated with nipple discharge. Correlation of findings on galactography and sonography. Clin Imaging 19:165–171CrossRefPubMed

Morrogh M, Morris EA, Liberman L, Borgen PI, King TA (2007) The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol 14(12):3369–3377. https://doi.org/10.1245/s10434-007-9530-5CrossRefPubMed

10.

Nicholson BT, Harvey JA, Patrie JT, Mugler JP III (2015) (2015), 3D-MR ductography and contrast-enhanced MR mammography in patients with suspicious nipple discharge; a feasibility study. Breast J 21:352–362. https://doi.org/10.1111/tbj.12417CrossRefPubMed

11.

Tokuda Y, Kuriyama K, Nakamoto A et al (2009) Evaluation of suspicious nipple discharge by magnetic resonance mammography based on breast imaging reporting and data system magnetic reso- nance imaging descriptors. J Comput Assist Tomogr 33:58–62CrossRefPubMed

12.

Bhattarai N, Kanemaki Y, Kurihara Y et al (2006) Intraductal papilloma: features on MR ductography using a microscopic coil. AJR Am J Roentgenol 186:44–7CrossRefPubMed

13.

Kanemaki Y, Kurihara Y, Itoh D et al (2004) MR mammary ductography using a microscopy coil for assessment of intraductal lesions. AJR Am J Roentgenol 182:1340–2CrossRefPubMed

14.

Srinivasan A, Nia E, Gupta M, Sun J, Leung JWT (2019) Retrospective statistical analysis on the diagnostic value of ductography based on lesion pathology in patients presenting with nipple discharge. Breast J 25:585–589. https://doi.org/10.1111/tbj.13298CrossRefPubMed

15.

Jiwa N, Kumar S, Gandhewar R, et al. (2022) Diagnostic accuracy of nipple discharge fluid cytology: a meta-analysis and systematic review of the literature. Ann Surg Oncol 29(3):1774–1786. https://doi.org/10.1245/s10434-021-11070-2CrossRefPubMed

16.

Filipe MD, Patuleia SIS, Vriens MR, van Diest PJ, Witkamp AJ (2021) Meta-analysis and cost-effectiveness of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge. Breast Cancer Res Treat 186(2):285–293. https://doi.org/10.1007/s10549-021-06094-xCrossRefPubMedPubMedCentral

17.

Denewer A, El-Etribi K, Nada N, El-Metwally M (2008) The role and limitations of mammary ductoscope in management of pathologic nipple discharge. Breast J 14(5):442–9. https://doi.org/10.1111/j.1524-4741.2008.00620.xCrossRefPubMed

18.

Baydoun S, Gonzalez P, Whitman GJ, Dryden M, Xi Y, Dogan B (2019) Is ductography still warranted in the 21st century? Breast J 25(4):654–662. https://doi.org/10.1111/tbj.13302CrossRefPubMed

19.

Hou MF, Huang TJ, Liu GC (2001) The diagnostic value of galactography in patients with nipple discharge. Clin Imaging 25:75–81CrossRefPubMed

20.

Cho N, Oh KK, Cho HY (2003) Galactographic differentiation between malignant and benign disease in patients with pathologic nipple discharge. J Korean Radiol Soc 48:511–516CrossRef

21.

Slawson SH, Johnson BA (2001) Ductography: how to and what if? Radiographics 21:133–150CrossRefPubMed

22.

Lamont JP, Dultz RP, Kuhn JA, Grant MD, Jones RC (2000) Galactography in patients with nipple discharge. Proc (Bayl Univ Med Cent) 13(3):214–6. https://doi.org/10.1080/08998280.2000.11927676CrossRefPubMed

23.

Choi Y, Kim SM, Jang M, et al. (2022) The value of adding ductography to ultrasonography for the evaluation of pathologic nipple discharge in women with negative mammography. Korean J Radiol 23(9):866–877. https://doi.org/10.3348/kjr.2021.0850CrossRefPubMedPubMedCentral

24.

Benndorf M, Baltzer PA, Vag T, Gajda M, Runnebaum IB, Kaiser WA (2010) Breast MRI as an adjunct to mammography: does it really suffer from low specificity? A retrospective analysis stratified by mammographic BI-RADS classes. Acta Radiol 51(7):715–21. https://doi.org/10.3109/02841851.2010.497164CrossRefPubMed

25.

Korhonen KE, Zuckerman SP, Weinstein SP, et al. (2021) Breast MRI: false-negative results and missed opportunities. Radiographics 41(3):645–664. https://doi.org/10.1148/rg.2021200145CrossRefPubMed

26.

Fleury EFC, Maragno B, Maragno B et al (2018) False negative carcinomas on breast magnetic resonance imaging: histological types, enhancement pattern and background parenchymal enhancement. Int J Radiol Radiat Ther 5(3):190–197. https://doi.org/10.15406/ijrrt.2018.05.00161CrossRef

27.

Foulkes RE, Heard G, Boyce T, Skyrme R, Holland PA, Gateley CA (2011) Duct excision is still necessary to rule out breast cancer in patients presenting with spontaneous bloodstained nipple discharge. Int J Breast Cancer. 6:495315

28.

Zee KJV, Pérez GO, Minnard E, Cohen MA (1998) Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge. Cancer 2000:82. https://doi.org/10.1002/(SICI)1097-0142(19980515)82:10%3c1874::AID-CNCR9%3e3.0.CO;2-NCrossRef

29.

Chow JS, Smith DN, Kaelin CM, Meyer JE (2001) Galactography- guided wire localization of an intraductal papilloma. Clin Radiol 56:72–73CrossRefPubMed

30.

Sharma N, Huston TL, Simmons RM (2006) Intraoperative intraductal injection of methylene blue dye to assist in major duct excision. Am J Surg 191(4):553–4. https://doi.org/10.1016/j.amjsurg.2005.07.032CrossRefPubMed

Title: Breast ductography: to do or not to do? A pictorial essay
Authors: Afsaneh Alikhassi
Belinda Curpen
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Mammography
Mammography
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01547-x

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Breast ductography: to do or not to do? A pictorial essay

Abstract

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