Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge

Abstract

METHODS. During 1994During -1996 RESULTS.Preoperative galactography was obtained in 7 of 31 patients (23%) with bloody nipple discharge and 9 of 15 patients (60%) with guaiac negative discharge. All patients undergoing preoperative galactography were found to have either a filling defect and/or duct cutoff (n Å 13) or duct ectasia (n Å 3). All patients with a filling defect and/or duct cutoff on galactogram were found to have a carcinoma or papilloma at surgery. In the three patients with duct ectasia observed on galactogram, the diagnosis was confirmed at surgery. All patients who underwent preoperative galactography were found to have specific pathology that accounted for the nipple discharge versus 20 of 30 patients (67%) who did not undergo preoperative galactography (P Å 0.009). CONCLUSIONS.Although major duct excision for nipple discharge may eliminate the presenting symptomatology, a pathologic correlate is not always found. The data from the current study show that localizing the causative lesion by preoperative galactography increases the likelihood that specific pathology will be found at surgery, and suggests that preoperative galactography may be helpful in the evaluation and management of patients presenting with spontaneous nipple discharge.

Ultrasound-guided wire localization of focal ductal dilatation in the evaluation and treatment of pathologic nipple discharge

“…These pathology findings underscore the clinical significance of PND and papillomas in general and challenge those who advocate nonoperative management of PND . These findings also contrast with pathology findings of duct ectasia, fibrocystic change, normal breast tissue, and even uninterpretable cauterized tissue that are commonly reported in the literature …”

“…Patients presenting with pathologic nipple discharge (PND) often pose a diagnostic and therapeutic challenge. While the clinical presentation of PND—spontaneous discharge of clear or bloody fluid from a single duct orifice—is readily apparent, the underlying causative lesion is often occult on physical and routine radiographic exam . In 4 studies reporting on a total of 692 patients with PND, clinical exam was normal in 81‐86% of patients, mammogram was negative in 67‐80%, and ultrasound showed no findings in 52‐60% .…”

“…Ductography, probe‐guided surgical excision, and ductoscopy are often used to evaluate PND; however, these techniques are limited by the difficulty of accessing and visualizing the delicate, branching ductal system from within. The default procedure of blind central duct excision is disconcerting in that large volumes of tissue are often removed with no certainty of excising the causative lesion …”

“…Some authors have accepted nonoperative surveillance unless PND presents with findings that suggest malignancy . Others stress the importance of surgical treatment with precise localization to ensure certain excision of the lesion causing PND . Their paramount concern is leaving atypia or carcinoma behind, particularly as surgical disruption of central ducts eliminates further PND and offers a false sense of security for patient and surgeon.…”

“…The results of surgery for PND are often disappointing. Studies report high rates of fibrocystic change and duct ectasia, both of which have been questioned as legitimate causes of PND …”