Ductography: How to and what if?

Ductography of the breast is an underused procedure that often helps define the cause of unilateral, single-pore, spontaneous nipple discharge. Since nipple discharge may be caused by benign tumors, such as papillomas, or by carcinoma, such as ductal carcinoma in situ, identification of intraductal abnormalities with ductography is important. Further, diagnostic ductograph y and preoperative ductography help guide accurate surgical intervention. W ithout prior ductography, central duct excision may not result in removal o f the abnormal ductal tissue or may result in removal of only a portion of the abnormal ductal system, causing the extent of disease to be effectively understaged. Once fundamental ductographic principles are learned, the pro cedure is easy to perform. If extravasation occurs, ductography is reschedu led for 7-14 days later. Elimination of air bubbles from the cannula, syrin ge, and extension tubing is vital. When reflux occurs, radiologists must be aware of a possible tumor in the distal-most duct. When ductal ectasia or fibrocystic changes are the cause of the discharge, conservative follow-up may be considered. Diagnostic radiologists who learn the technique of ducto graphy and include it in their evaluation of nipple discharge will improve their interdisciplinary approach to this important sign of breast cancer.