Galactography: method of choice in pathologic nipple discharge?

Abstract

Our objective was to assess the role of galactography in the diagnostic work-up of patients with pathological nipple discharge together with exfoliative cytology, and investigation of secretion colour. All galactographies performed in this center between 1993 and 1998 were evaluated retrospectively. In 134 cases, outcomes, defined as either a postoperative histology or a negative follow-up over 2 years after galactography, were available. In 96 of these cases, exfoliative cytology was performed, and in 65 cases the colour of the secretion was determined. Galactograms, cytological findings and colour of the secretions were compared with the outcomes. At galactography, the radiographic findings had the following individual sensitivities/specificities in detecting carcinomas: filling defect 55.6%/ 62.1%; ductectasia 22.2%/94%; and filling stop 5.6%/77.6%. Normal galactograms (n=33, 25%) had a sensitivity of 78% and a specificity of 93% in predicting absence of disease. Technically inadequate investi-gations occurred in 16 (12%) cases. Cytology showed 69.2%/66.8% for papillomatous borderline or malignant cells; 53.8%/75.3% for borderline or malignant cells; and 7.7%/100% for one case of malignant cells. For the assessment of pathological secretions, galactography is a sensitive but unspecific method for the detection of papillomas or carcinomas. Filling defects, ductectasia and ductal distortion carry the highest levels of suspicion for carcinoma. A normal galactogram is a specific yet moderately sensitive indicator of absence of localized disease. Exfoliative cytology shows low sensitivity but better specificity for carcinomas when borderline or malignant cells are found. In the present series, the colour of the secretions does not add significant information about underlying pathology.

Breast Sonography in Localizing the Cause of Nipple Discharge

“…The discharging duct may be identified before surgical excision by reviewing the diagnostic galactographic images, 4,6,8 staining with methylene blue dye, 2,3,5,9,10 or inserting a lacrimal probe or an endoscope into the duct immediately preoperatively. 7,10,11 Localization has been found to facilitate selective excision of the duct 9 and to increase the likelihood of finding a specific underlying abnormality.…”

“…Technical problems, mostly failures in cannulation, have been reported in 12% to 44% of diagnostic and 16% to 27% of preoperative galactographic examinations. 2,6,9,12 In these situations, the surgeon can either operate and try to remove the discharging duct on the basis of clinical and earlier galactographic findings, which can lead to unnecessarily wide excision of breast tissue or failure in removing the cause of nipple discharge, or cancel the procedure and plan a repeated methylene blue staining, which is frustrating for the patient.…”

Selective microdochectomy after ductoscopic wire marking in women with pathological nipple discharge

“…after instillation of methylene blue dye into the pathological duct only allows an indirect view of the lactiferous ducts from the exterior. In combination with galactography [2,3,22-26] it is possible for the surgeon to identify the blue coloured lactiferous duct system and excise them. With this technique however, microdochectomy follows without direct visualisation of the lesion.…”

“…It is define as spontaneous, persistent, unilateral and coming from a single duct during non-lactational period [1]. The imaging techniques mammography and galactography [2,3] as well as sonography and magnetic resonance imaging (MRI) cannot replace histological examination in patients with pathologic nipple discharge (Fig. 1).…”

Conventional Galactography and MR Contrast Galactography for Diagnosing Nipple Discharge: Preliminary Results

“…Galactography also avoids incomplete and/or excessive removal of breast tissue by identifying the abnormal ductal system (3, 4). Nevertheless, the use of X-rays and the images obtained from a compressed breast constitute the disadvantages of conventional galactography (CG).…”