Ductogram
A ductogram, also known as a mammary ductogram or galactogram, is a specialized imaging procedure that enhances mammography images using a radio-opaque contrast dye. This technique is primarily employed to investigate the source of abnormal nipple discharge and to locate potential cancer within the milk ducts of the breast, particularly in lactating women. It can help identify conditions like breast cancer and ductal carcinoma in situ (DCIS), where cancer cells are found in the ducts.
During the procedure, a radiologist injects the contrast dye into the affected duct and then takes imaging to capture detailed views of the area. Patients are generally advised to avoid certain products on the day of the procedure and should inform their healthcare provider about any pregnancy. While ductograms are generally low-risk, they can involve some discomfort and a small chance of complications.
Results from the ductogram can indicate abnormalities, such as signs of cancer, and the procedure may be combined with other imaging techniques like mammography and ultrasound, though it is increasingly being supplemented by dynamic contrast-enhanced magnetic resonance imaging. Overall, ductograms are a valuable diagnostic tool for understanding issues related to nipple discharge and breast health.
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Subject Terms
Ductogram
ALSO KNOWN AS: Mammary ductogram, galactogram, galactography, ductogalactography
DEFINITION: A ductogram is an imaging procedure that uses a radio-opaque contrast dye to enhance mammography pictures. It helps identify cancer in the duct of the nipple, which transports breast milk in lactating women.
Cancers diagnosed:Breast cancer, ductal carcinoma in situ (DCIS)
Why performed: A ductogram is used to help determine the source of abnormal nipple discharge and the location of possible cancer. Cancer may cause abnormal nipple discharge. DCIS begins as cancer in the cells that line the ducts. The cancer may remain contained in the nipple or may spread to other parts of the breast. Standard mammography may show small areas of microcalcifications, calcium collections that can be a sign of DCIS. A ductogram creates even better pictures of the suspicious area.
Patient preparation: The patient should not use deodorant or powder on the day of the ductogram. The patient should not express discharge from the nipple before the procedure but should let her doctor know if she does not experience nipple discharge on the day of the procedure. In such cases, the ductogram may need to be rescheduled. The patient should inform her doctor if she is pregnant so that a protective drape will be placed over the abdomen during the procedure.
A ductogram is performed by a radiologist in the radiology department of a hospital or an outpatient radiology center. It is an outpatient procedure that lasts from thirty minutes to an hour. The patient disrobes from the waist up and wears an examination gown for the procedure.
Steps of the procedure: The breast and nipple are cleansed before the procedure. The nipple is sterilized with alcohol. The radiologist applies pressure to the nipple to elicit discharge to identify which duct is producing abnormal discharge. Local anesthesia may be applied before a blunt-tipped cannula, a small needlelike device, is inserted into the duct. A syringe attached to the cannula delivers the radiopaque contrast dye. The cannula is removed, and mammography images are taken.
After the procedure: A bandage is placed over the nipple. Patients should drink plenty of fluids to help eliminate the dye from the body.
Risks: A ductogram is a low-risk procedure, but pain, infection, or bleeding may occur.
Results: A healthy nipple does not reveal abnormalities. Any abnormalities, such as possible cancer, are highlighted on ductogram images. Although ductograms, in combination with mammography and ultrasound, are still used worldwide to determine if cancerous cells exist in ducts, they are also being replaced by dynamic contrast-enhanced magnetic resonance imaging.
Bibliography
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Baydoun, Serine et al. “Is Ductography Still Warranted in the 21st Century?.” The Breast Journal, vol. 25.4, 2019, pp. 654-662, doi:10.1111/tbj.13302.
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Harvey, Jennifer. Making the Diagnosis: A Practical Guide to Breast Imaging. Philadelphia: Elsevier, 2013.
Kato, Meredith, and Rache M. Simmons. "The Evaluation and Treatment of Nipple Discharge." Breast Surgical Techniques and Interdisciplinary Management. New York: Springer, 2011, pp. 179–86.
Link, John. The Breast Cancer Survival Manual: A Step-by-Step Guide for Women with Newly Diagnosed Breast Cancer. 5th ed. New York: Holt, 2012.
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