Is Ductography Still Warranted in the 21st century?

Abstract

Objective To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple‐modality evaluation. Materials and Methods We retrospectively reviewed the medical records of patients who had presented with pathologic nipple discharge and had undergone mammography and/or ultrasound and ductography between January 1, 2005, and October 31, 2010. We tested the diagnostic sensitivity, specificity and accuracy of combined triple‐modality evaluation as well as of MRI performed in addition to these imaging techniques. We used the gold standard of image‐guided biopsies, surgical excision, or long‐term clinical and imaging follow‐up. Results Among 94 study patients, benign papillomas were identified in 42 (44.7%), abscess in one (1%), duct ectasia in four (4.3%), and malignancy (invasive ductal carcinoma or ductal carcinoma in situ) or high‐risk lesion (atypical ductal hyperplasia) in 10 (10.6%). Forty‐six patients (49%) underwent surgical excision; 89.1% of which had presurgical planning with ductography. In 35 (37.2%) with negative imaging, resolution of nipple discharge was confirmed on median clinical and imaging follow‐up of 36 months. Two patients with negative imaging were lost to follow‐up. Sensitivity, specificity, PPV, and NPV for accurately demonstrating the etiology of pathologic nipple discharge were 13%, 97%, 89%, and 37% respectively for mammography; 73%, 97%, 98%, and 64% respectively for ultrasound; 76%, 72%, 84%, and 61% respectively for ductography; 86%, 70%, 85%, and 72% respectively for combined ultrasound and ductography; and 75%, 100%, 100% and 67% respectively for DCE‐MRI. Conclusion The combination of mammography, ultrasound and ductography is highly accurate for identifying the etiology of pathologic nipple discharge. DCE‐MRI can be used as an alternate to ductography if necessary.

The Value of Adding Ductography to Ultrasonography for the Evaluation of Pathologic Nipple Discharge in Women with Negative Mammography

“…ACR guidelines recommend mammography or digital breast tomosynthesis as the initial examination for women aged ≥ 40 years [ 7 ]. Positive mammography findings in patients with PND include microcalcifications, mass lesions, architectural distortion, asymmetry, and/or solitary dilated ducts [ 21 27 28 ]. The benefits of additionally performing ductography for mammography-positive patients remain unclear, although several reports have shown various rates of correlation (80.0% [4/5]–33.4% [2/6]) between ductography and mammography findings for malignant lesions [ 21 27 ].…”

“…Positive mammography findings in patients with PND include microcalcifications, mass lesions, architectural distortion, asymmetry, and/or solitary dilated ducts [ 21 27 28 ]. The benefits of additionally performing ductography for mammography-positive patients remain unclear, although several reports have shown various rates of correlation (80.0% [4/5]–33.4% [2/6]) between ductography and mammography findings for malignant lesions [ 21 27 ]. Moreover, ductography has been shown to facilitate preoperative localization of the causative lesion in 36% (13/36) of the cases [ 29 ].…”

Ductography and Galactomosynthesis in the 21st Century: Role of Imaging in Identifying Endoductal Breast Lesions and in Pre-Surgical Planning

“…Ductography might have self-limiting minor complications (such as duct per-Open Journal of Radiology foration and extravasation of the contrast material) [3]. The technical failure is considered to be a limitation.…”

“…In literature, the most common cause of nipple discharge is benign diseases such as intraductal lesion. However, PND can also be the first sign of underlying malignancy (in a small percentage, with an incidence varying in literature from 5% to 23%) [2] [3].…”

Evaluation of Breast Galactography Using Digital Breast Tomosynthesis: A Clinical Exploratory Study

“…Galactography is an X-ray examination that uses mammography and an iodinated contrast to obtain imaging of the inside of the duct to evaluate lesions causing nipple discharge. Recent studies have shown that galactography helps in precisely locating masses within breast tissue and provides useful information for the surgical approach and planning [9].…”