Predictive value of galactographic patterns for benign and malignant neoplasms of the breast in patients with nipple discharge

The purpose was to identify features of malignant and non-malignant neoplas tic breast disease on galactography and to estimate their predictive value. This is the largest reported study correlating galactographic morphologica l patterns with histopathology and the only blinded study. The study includ ed 351 consecutive galactograms and 161 breast biopsies performed in patien ts with nipple discharge over a 10-year period. Three radiologists, blinded to clinical data and histological results, re-evaluated 158 previously per formed galactograms of patients who had undergone excision biopsy. Extravas ation or incomplete filling precluded reading in 9.5% of examinations. Amon g the remaining 143 examinations there were 11 cancers (7.7%), 56 papilloma s (39.2%), 19 cases of intraductal papillomatous proliferation (13.3%), 55 cases of fibrocystic or secretory disease (38.5%) and two normals. A "filli ng defect/cut-off' pattern (n=90) was found in 6 cancers (6.7%) and 58 case s of papilloma or papillomatous proliferation (64.4%). A "leafless tree" pa ttern was found only in benign cases (n=12 8.4%). In 32 of 143 cases (22.4% ) a "ductal ectasia" pattern was present, in one case of which (3.1%) cance r was found. Cancer was identified in two of four cases with an "architectu ral distortion" pattern. Cancer is rare ill patients with nipple discharge. A tendency towards a lower incidence of cancer associated with the "ductal ectasia" and ''leafless tree" patterns was found. No statistical evidence was found to indicate that galactography provides an effective prospective diagnosis of malignancy. However, an abnormal galactogram strongly correlat ed (p<0.001) with the presence of a breast neoplasm when both benign and ma lignant tumours were considered. The most important role played by galactog raphy is in the localization of breast neoplasms and in the choice of appro priate surgical therapy.