1. Breast Ductography:Evaluation and Surgical Planning
2.INTRODUCTION: Breast ductography, sometimes referred to as galactography, is an imaging modality used to assess lesions resulting in discharge from the breasts. It offers helpful information for surgical approach and planning and aids in accurately finding the lump within breast tissue.
3. ANATOMY
4. Indications:If a single duct has a discharge, breast ductography is recommended.
Contraindications: When there are two or more discharging ducts, breast ductography is not recommended since the cause is either physiological or systemic.
5. Surgery: It helps locate the mass within breast tissue and provides useful information for surgical planning.
Excision of lesions: Surgery for breast ductography involves excising the majority of lesions found in ducts, such as intraductal papillomas.
Ultrasound-Guided Percutaneous Biopsy: For smaller lesions, ultrasound-guided percutaneous biopsy can be used.
Duct Excision with Dye: The duct is excised after it is filled with dye.
6. Procedure : A blunt-tipped sialogram needle is used in breast ductography procedure to perform the ductogram.
Once the aberrant duct has been located and cannulated, 1-2 mL of contrast agent is administered.
Images taken from standard mammography are obtained.
7. The tip of the cannula is inserted into the duct opening once the duct causing the discharge has been located.
The cannula is then carefully straightened. The cannula typically falls in the duct to the hub in patients. There is no force applied. Cannulation shouldn't cause any pain for the patient.
8. Before injecting contrast, watch the tubing for a short while after cannulation.
Since the duct is cannulated and the tubing is now part of a closed system, it is occasionally possible to view the contents of the duct refluxing into the tubing. This indicates that the duct producing the discharge has been cannulated if it is observed.
9. When contrast is injected into the cannula, duct contents occasionally form a droplet (arrow) around the cannula if they do not reflux into the tubing. Duct contents are displaced by the contrast. Observing this verifies that the duct causing the discharge has been cannulated.
10. Following the injection of 0.2 to 0.4 mL of contrast, the cannula is secured to the nipple with two pieces of paper tape. Leaving the cannula in situ allows for additional contrast injections when duct evaluation is required. Additionally, the cannula lessens the quantity of contrast that compression forces out of the duct.
11. Intraductal Abnormalities
Filling defects. Fusiform or tubular dilatation of ducts
Abrupt ductal cut off.
Causes of Abnormalities
The intraductal abnormalities observed on mammography can have both pathological and artifactual causes.
12. Complications: Duct Perforation, Pain or Burning Sensation, Infection.
13. It matters more how a patient perceives the discharge than what kind of discharge it is.
2. INTRODUCTION
• Breast ductography, sometimes referred to
as galactography, is an imaging modality
used to assess lesions resulting in
discharge from the breasts. It offers helpful
information for surgical approach and
planning and aids in accurately finding the
lump within breast tissue.
4. Indications
If a single duct has a discharge, breast ductography is
recommended.
Contraindications
When there are two or more discharging ducts, breast
ductography is not recommended since the cause is
either physiological or systemic.
BLOOD DISCHARGE
ECTASIA
5. • Surgery
• It helps locate the mass within breast tissue and
provides useful information for surgical planning.
• Excision of lesions
• Surgery for breast ductography involves excising the
majority of lesions found in ducts, such as intraductal
papillomas.
• Ultrasound-Guided Percutaneous Biopsy
• For smaller lesions, ultrasound-guided percutaneous
biopsy can be used.
• Duct Excision with Dye
• The duct is excised after it is filled with dye.
6. Breast Ductography Procedure
• A blunt-tipped sialogram needle is used in breast
ductography procedure to perform the ductogram.
• Once the aberrant duct has been located and
cannulated, 1-2 mL of contrast agent is administered.
• Images taken from standard mammography are
obtained.
TechniquE
7. The tip of the cannula is inserted
into the duct opening once the duct
causing the discharge has been
located.
The cannula is then carefully
straightened. The cannula typically
falls in the duct to the hub in
patients.
There is no force applied.
Cannulation shouldn't cause any
pain for the patient.
8. Before injecting contrast, watch the tubing
for a short while after cannulation.
Since the duct is cannulated and the tubing
is now part of a closed system, it is
occasionally possible to view the contents of
the duct refluxing into the tubing. This
indicates that the duct producing the
discharge has been cannulated if it is
observed.
9. When contrast is injected into the cannula,
duct contents occasionally form a droplet
(arrow) around the cannula if they do not
reflux into the tubing. Duct contents are
displaced by the contrast. Observing this
verifies that the duct causing the discharge
has been cannulated.
10. Following the injection of 0.2 to 0.4
mL of contrast, the cannula is secured
to the nipple with two pieces of paper
tape. Leaving the cannula in situ
allows for additional contrast
injections when duct evaluation is
required. Additionally, the cannula
lessens the quantity of contrast that
compression forces out of the duct.
11. RADIOGRAPHIC ASSESSMENT
Causes of Abnormalities
• The intraductal
abnormalities observed on
mammography can have
both pathological and
artifactual causes.
Intraductal Abnormalities
• Filling defects
• Fusiform or tubular dilatation
of ducts
• Abrupt ductal cut off
12. COMPLICATIONS
• Duct
Perforation
• Complication
where the duct
is punctured
during the
procedure.
• Infection
• There is a risk
of infection
following
breast
ductography.
• Pain or
Burning
Sensation
• Patients may
experience pain
or a burning
sensation after
the procedure.
13. COMMON ASSUMPTIONS IN WOMEN WITH NIPPLE DISCHARGE
Assumption
• Pathology is consistently ruled out by negative
cytology results.
• The only substantial secretion from a nipple is blood.
• It is possible to accurately determine the position and
size of a lesion inside the duct during surgery,
allowing the dissection to be expanded as necessary
to encompass the lesion without crossing it.
• When examining the material for histologic analysis,
the pathologist can accurately pinpoint the lesion's
location.
Fact
• Significant pathology cannot always be ruled out
by negative cytology.
• Heme occult-negative, clear, or serous nipple
discharge may be the initial symptom of ductal
cancer in situ.
• Not all papillomas are located in the subareolar
region, and when cancer is present, it is
frequently widespread rather than subareolar.
• Methylene blue staining of the duct makes it
easier for the surgeon to identify it during surgery
and for the pathologist to process the specimen.
It matters more how a patient perceives the discharge than what kind of discharge it is. Most
of the time, expressed nipple discharge is physiological. Regardless of how it appears,
spontaneous nipple discharge needs to be investigated.
