Imaging Approaches to Diagnosis and Management of Common Ductal Abnormalities

Abstract

Ductal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal-lobular unit. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling.

Papillary breast lesions on contrast-enhanced ultrasound: morphological enhancement patterns and diagnostic strategy

“…Ultrasound (US) is a valuable adjunct to mammography, as it is a more sensitive method for detecting duct dilation. US can help visualise intraductal abnormalities [7]. However, US is often unable to distinguish intraductal papillomas from hypervascular benign breast lesions, unless there is clear evidence of intraductal origin on the sonogram.…”

Clinics in diagnostic imaging (180)

“…It is usually filled with fluid but can demonstrate internal echoes due to secretions and cellular debris, which are generally mobile on real-time ultrasonography. (12) Nodular sclerosing adenosis can present as lobulated, tubular-type masses. Abscess, granulation mastitis and periductal mastitis commonly show distended ducts with mobile echogenic intraductal material and periductal hyperaemia.…”

Scope of Breast Imaging in Developing Countries

“…Ductography was the standard investigation for evaluation of single duct discharge; however, it is fast being replaced with high resolution ultrasound and MRI. 17 Ultrasound is accurate in delineating the abnormally dilated duct often with an intraductal nodule or mass. If identified, its size, location on clock face and distance from the nipple should be carefully documented in the report to help the surgeon in planning the extent of duct excision (microdochectomy instead of radical duct excision).…”