Galactography: the diagnostic procedure of choice for nipple discharge.

Abstract

Galactography was performed in 204 women with a nipple discharge and the secretion confirmed histopathologically. All 116 intraductal tumors (papilloma, papillomatosis, carcinoma), which were associated with a serous or bloody discharge, were detected preoperatively. A palpable mass had little diagnostic significance, and exfoliative cytology was positive in only 11% (2/18) of the patients with carcinoma. The authors recommend that all patients with a spontaneous bloody or serous discharge from a single lactiferous orifice undergo galactography in addition to physical, cytological, and mammographic examination. Intraductal injection of methylene blue dye will demonstrate the affected duct system to the surgeon and can often make surgery less radical or even unnecessary.

Galactography in Patients with Nipple Discharge

“…Abnormal nipple discharge is associated with an underlying malignancy in 1.2% to 15% of patients (1)(2)(3)(4)(5). Abnormal discharge is defined as nonlactational, persistent, spontaneous, and unilateral (6).…”

“…Characteristics of a benign source include a milky, bilateral discharge, which does not require further follow-up. The discharge is due to an underlying malignant lesion, however, in up to 15% of cases (1)(2)(3)(4)(5). Discharge from a malignant source is spontaneous, unilateral, persistent, and nonlactational (6).…”

“…These include the infrequent identification of a mass lesion on examination and the occasional abnormal mammogram. Cytology of the discharge itself is often unrevealing and is not helpful in localizing a tumor (1,5). Galactography (ductography) is often used to localize and characterize ductal abnormalities.…”

Ductography: The Diagnostic Procedure of Choice in Patients with Abnormal Nipple Discharge

“…1 Abnormal discharge is defined as nonlactational, persistent, spontaneous, and unilateral. 2 Bloody or hemoccult-positive discharge is more likely to be associated with cancer (5% to 28%) and should prompt further evaluation.…”

“…3 However, clear or watery discharge has been associated with breast cancer in up to 7% of cases. 1 Mammography is advocated as part of the routine evaluation of women with breast complaints. Mammography is associated with a 9.5% false-negative rate and a 1.6% false-positive rate in detecting breast cancer in patients with nipple discharge.…”