Answer
Ductography (galactography) is not indicated unless the nipple discharge is spontaneous, unilateral, and expressed from a single pore. Ductography is occasionally technically impossible because of failed catheterization of the pore because of the need to reproduce the discharge on the day of the investigation. It is invasive, with a risk of extravasation and complications due to allergy to the iodinated contrast medium, or mastitis. [3] Ductoscopy detects about 94% of all underlying malignancies in patients with PND, but it oes not permit reliable discrimination between malignant and benign findings. [6]
The major disadvantage of MRI is that it often detects additional images or false positives, which result in MRI monitoring or biopsies being taken that are unrelated to the pathologic nipple discharge. It appears to be more difficult with this technique to characterize an endoductal lesion and therefore guide the diagnosis toward a benign or malignant lesion, which then necessitates repeat ultrasound. [3]
High-resolution ultrasonography is not available at all breast-imaging centers. In addition, it is operator dependent and requires expertise for the identification of small intraductal structures.
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A 42-year-old woman with serous discharge from her left nipple. Ductography reveals contrast-agent filling defects approximately 1.5 cm from her nipple. Cytology of smears of secreted fluid revealed malignant epithelial cells. Histopathology after surgery revealed intraductal carcinoma.
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Close-up view of the immediately preceding image.
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A 47-year-old woman with serous discharge from her right nipple. Ductography reveals a contrast-agent filling defect approximately 3 cm from the nipple. Cytology revealed normal epithelial cells and cell debris. Histopathology after surgery revealed a solitary, lobulated intraductal papilloma.
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Close-up view of the immediately preceding image.
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A 50-year-old woman with serous discharge from her right nipple. Ductography reveals contrast-agent filling defect approximately 4 cm from her nipple. Cytology of the smears from her nipple discharge revealed normal epithelial cells. Histopathology after surgery revealed a solitary intraductal papilloma in a cystic lesion.
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Close-up view of the immediately preceding image.
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A 48-year-old woman with serous discharge from her right nipple. Ductography reveals contrast-agent filling defects approximately 1.5 cm from the nipple, extending to a depth of approximately 2.5 cm. Cytology demonstrated epithelial cells arranged in papillary fragments. Histopathology after surgery revealed extensive involvement of intraductal papillomas.
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Close-up view of the immediately preceding image.
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A 45-year-old woman with serosanguineous discharge from her right nipple presented with no other clinical symptoms. Mammography was unrevealing. Ultrasonography revealed a 3-mm dilated duct with an intraluminal lesion (arrow) located close to the nipple. Cytology revealed epithelial cell fragments in a papillary formation. Histopathology confirmed the presence of a papilloma.
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Additional ultrasonogram obtained in the same patient as in the immediately preceding image.
