The In’s and Out’s of Ductography: A Comprehensive Review

Sheiman, Laura S.; Levesque, Paul H.

doi:10.1067/j.cpradiol.2015.05.007

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…However, no general consensus exists in the medical literature, and cytological examination of nipple discharge has not been found to provide any significant complementary value [1,6]. In case of inconclusive mammographic or ultrasonography findings, a second line examination should be considered [17].…”

Section: Discussionmentioning

confidence: 99%

DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge

et al. 2020

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Background: Our aim was to compare the diagnostic performance of digital breast tomosynthesis (DBT)galactography with that of full-field digital (FFD)-galactography for detecting intraductal breast lesions using an intra-individual design. Methods: Forty-nine consecutive patients with spontaneous, unilateral, single-pore nipple discharge and inconclusive FFD mammography and ultrasonography underwent galactography with a "COMBO" technique combining FFD-and DBT-galactography acquisitions. Examinations were independently analysed by two breast radiologists with 10-year experience. Sensitivity, specificity, and accuracy for both FFD-and DBT-galactography were calculated having histological examinations of surgical specimens as a reference standard. Data were presented as percentages with their 95% confidence intervals (CI). McNemar test was used. Interobserver agreement was assessed by using Cohen κ test for both techniques. Results: Sensitivity was 41/43 (95%, 95% CI 84.2-99.4) for DBT-galactography and 33/43 (77%, 95% CI 61.4-88.2) for FFD-galactography (p = 0.008), specificity 6/6 (100%, 95% CI 54.1-100.0) for both imaging tools, accuracy 47/49 (96%, 95% CI 86.0-99.5) and 39/49 (80%, 95% CI 65.7-89.8) (p = 0.038), respectively. The inter-observer agreement was 0.86 for DBT-galactography and 0.78 for FFD-galactography. The AGD resulted to 1.94 ± 0.64 for the combined technique. Conclusion: DBT-galactography showed a significantly higher sensitivity and accuracy than FFD-galactography for the identification of the intraductal findings, improving the possibility of a reliable diagnosis in patients with pathologic nipple-discharge.

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Section: Discussionmentioning

confidence: 99%

DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge

et al. 2020

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“…These were topical lacerations due to direct skin contact and not from internal tissue damage. The risk of these lacerations will be much lower by taping the nipple after ductal injection as it is routine practice for ductography [3, 8]. We did not observe any long-term effects of EtOH injection; specifically, none of the mice had open wounds or infection in injected glands nor did they exhibit any overt signs of pain, distress, or discomfort.…”

Section: Discussionmentioning

confidence: 73%

“…For the injection of more than 3 glands per mouse, a sequential procedure was performed to allow enough recovery time. The risk of alcohol intoxication in women will be much lower; injection of ductal trees in both breasts, assuming 24 main ducts [41, 42] and 2 mL per duct [3, 8], with 70% EtOH will result in less than 0.1 g/dL of EtOH content in blood, which approximates to drinking three glasses of wine (15 oz), and may cause mild impairment. The total volume of 50 mL of 70% EtOH and total EtOH quantity (27.61 g) is comparable to the up to 50 mL of 95–100% EtOH (up to 39.45 g) reported in percutaneous EtOH injection procedures for the treatment of liver tumors [20] and venous malformations [28].…”

Section: Discussionmentioning

confidence: 99%

“…EtOH could be injected with a radiocontrast agent to visualize ductal tree filling (as shown in Fig. 1 for mice) using existing ductography methods [3, 8] or could be intrinsically labeled for visualization using other imaging modalities such as EtOH- 17 O for magnetic resonance imaging [51]. In some cases, hyperplastic or proliferative regeneration may occlude a duct, preventing filling of the entire ductal tree.…”

Section: Discussionmentioning

confidence: 99%

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Ductal tree ablation by local delivery of ethanol prevents tumor formation in an aggressive mouse model of breast cancer

et al. 2019

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BackgroundProphylactic mastectomy is the most effective intervention to prevent breast cancer. However, this major surgery has life-changing consequences at the physical, emotional, psychological, and social levels. Therefore, only high-risk individuals consider this aggressive procedure, which completely removes the mammary epithelial cells from which breast cancer arises along with surrounding tissue. Here, we seek to develop a minimally invasive procedure as an alternative to prophylactic mastectomy by intraductal (ID) delivery of a cell-killing solution that locally ablates the mammary epithelial cells before they become malignant.MethodsAfter ID injection of a 70% ethanol-containing solution in FVB/NJ female animals, ex vivo dual stained whole-mount tissue analysis and in vivo X-ray microcomputed tomography imaging were used to visualize ductal tree filling, and histological and multiplex immunohistochemical assays were used to characterize ablative effects and quantitate the number of intact epithelial cells and stroma. After ID injection of 70% ethanol or other solutions in cancer-prone FVB-Tg-C3(1)-TAg female animals, mammary glands were palpated weekly to establish tumor latency and examined after necropsy to record tumor incidence. Statistical difference in median tumor latency and tumor incidence between experimental groups was analyzed by log-rank test and logistic mixed-effects model, respectively.ResultsWe report that ID injection of 70% ethanol effectively ablates the mammary epithelia with limited collateral damage to surrounding stroma and vasculature in the murine ductal tree. ID injection of 70% ethanol into the mammary glands of the C3(1)-TAg multifocal breast cancer model significantly delayed tumor formation (median latency of 150 days in the untreated control group [n = 25] vs. 217 days in the ethanol-treated group [n = 13], p value < 0.0001) and reduced tumor incidence (34% of glands with tumors [85 of 250] in the untreated control group vs. 7.3% of glands with tumor [7 of 95] in the ethanol-treated group, risk ratio = 4.76 [95% CI 1.89 to 11.97, p value < 0.0001]).ConclusionsThis preclinical study demonstrates the feasibility of local ductal tree ablation as a novel strategy for primary prevention of breast cancer. Given the existing clinical uses of ethanol, ethanol-based ablation protocols could be readily implemented in first-in-human clinical trials for high-risk individuals.

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“…Diagnostic mammography is the standard initial step in the evaluation of a patient with pathologic nipple discharge [4,5], and it has the ability to detect very small lesions in the specific duct with pathologic nipple discharge [6][7][8]. 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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Objectives: To compare the application value of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in breast galactography. Materials and Methods: A total of 128 patients with pathological nipple discharge (PND) were selected to undergo galactography. DBT and FFDM were performed for each patient after injecting the contrast agent; the radiation dose of DBT and FFDM was calculated, and the image quality was evaluated in consensus by two senior breast radiologists. Histopathologic data were found in 49 of the 128 patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both FFDM- and DBT-galactography were calculated using histopathologic results as a reference standard. Data were presented as percentages along with their 95% confidence intervals (CI). Results: The average age of the 128 patients was 46.53 years. The average glandular dose (AGD) of DBT-galactography was slightly higher than that of FFDM-galactography (p < 0.001). DBT-galactography was 30.7% higher than FFDM-galactography in CC view, while DBT-galactography increased by 21.7% compared with FFDM-galactography in ML view. Regarding catheter anatomic distortion, structure detail, and overall image quality groups, DBT scores were higher than FFDM scores, and the differences were significant for all measures (p < 0.05). In 49 patients with pathological nipple discharge, we found that the DBT-galactography had higher sensitivity, specificity, PPV, and NPV (93.3%, 75%, 97.7%, and 50%, respectively) than FFDM-galactography (91.1%, 50%, 95.3%, and 33.3%, respectively). Conclusions: Compared to FFDM-galactography, within the acceptable radiation dose range, DBT-galactography increases the sensitivity and specificity of lesion detection by improving the image quality, providing more confidence for the diagnosis of clinical ductal lesions.

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The In’s and Out’s of Ductography: A Comprehensive Review

Cited by 13 publications

References 8 publications

DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge

DBT-galactography: a promising tool for improving the diagnostic workup of nipple discharge

Ductal tree ablation by local delivery of ethanol prevents tumor formation in an aggressive mouse model of breast cancer

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

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