Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge

Zee, Kimberly J. Van; Pérez, Gloria Ortega; Minnard, Emery A.; Cohen, Michael A.

doi:10.1002/(sici)1097-0142(19980515)82:10<1874::aid-cncr9>3.0.co;2-n

Cited by 94 publications

(10 citation statements)

References 25 publications

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“…27 The 2 most common causes of pathologic nipple discharge are intraductal papilloma and ductal ectasia, both of which can be seen via ultrasound. [28][29][30] Duct ectasia is often asymptomatic and discovered incidentally at screening, but may present with bilateral or multiductal nipple discharge. It may develop secondary to ductal inflammation or obstruction and is not associated with an increased risk of carcinoma.…”

Section: Clinical Significancementioning

confidence: 99%

Management of Nipple Discharge and the Associated Imaging Findings

Patel

Falcon

Drukteinis

2015

The American Journal of Medicine

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Section: Clinical Significancementioning

confidence: 99%

Management of Nipple Discharge and the Associated Imaging Findings

Patel

Falcon

Drukteinis

2015

The American Journal of Medicine

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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BackgroundTo investigate the diagnostic reliability of selective microdochectomy after direct ductoscopic wire marking of suspect lesions in patients with pathological nipple discharge.MethodsSelective microdochectomy due to pathological discharge was performed in 33 patients with mean age of 51.7 years. Ductoscopes of 0.9 and 1.1 mm in diameter with a channel for wire marking were used. Only patients without sonographic or mammographic correlation for the discharge were included. The pathologic mammary duct was wire marked and extirpated under direct visual guidance via the ductoscope. The histological results were compared with cytology, galactography and ductoscopy.ResultsIn 24 out of 33 cases (72%) an intraductal, epithelial proliferation was found histologically. The following sensitivities for intraductal, epithelial proliferations could be determined: cytology 4%, galactography 74%, and ductoscopy 78%.ConclusionThe method allows selective microdochectomy of the pathological duct and the intraductal proliferation under visual guidance. The resection volume can be reduced in contrast to the unselective ductectomy after injection of methylene blue.

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“…Patients presenting with pathologic nipple discharge (PND) often pose a diagnostic and therapeutic challenge. While the clinical presentation of PND—spontaneous discharge of clear or bloody fluid from a single duct orifice—is readily apparent, the underlying causative lesion is often occult on physical and routine radiographic exam . In 4 studies reporting on a total of 692 patients with PND, clinical exam was normal in 81‐86% of patients, mammogram was negative in 67‐80%, and ultrasound showed no findings in 52‐60% .…”

Section: Introductionmentioning

confidence: 99%

“…Ductography, probe‐guided surgical excision, and ductoscopy are often used to evaluate PND; however, these techniques are limited by the difficulty of accessing and visualizing the delicate, branching ductal system from within. The default procedure of blind central duct excision is disconcerting in that large volumes of tissue are often removed with no certainty of excising the causative lesion …”

Section: Introductionmentioning

confidence: 99%

“…Some authors have accepted nonoperative surveillance unless PND presents with findings that suggest malignancy . Others stress the importance of surgical treatment with precise localization to ensure certain excision of the lesion causing PND . Their paramount concern is leaving atypia or carcinoma behind, particularly as surgical disruption of central ducts eliminates further PND and offers a false sense of security for patient and surgeon.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-guided wire localization of focal ductal dilatation in the evaluation and treatment of pathologic nipple discharge

et al. 2017

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Patients presenting with pathologic nipple discharge (PND) often pose a diagnostic and therapeutic challenge. We used ultrasound to identify focal ductal dilatationhypothesized to be a radiographic manifestation of the causative lesion-in patients with PND and no relevant clinical or radiographic findings. Twenty-two excisions guided by ultrasound wire localization of focal duct dilation were performed. Surgical pathology revealed papilloma in 20 cases (91%); atypia or carcinoma was detected in 7 cases (32%). The ultrasound finding of focal duct dilatation enables excision of otherwise occult though clinically significant lesions and is worthy of further study. The challenge of identifying and excising the causative lesion has led to a lack of consensus on the management of PND. Some authors have accepted nonoperative surveillance unless PND presents with findings that suggest malignancy. 1,5,7 Others stress the importance of surgical treatment with precise localization to ensure certain excision of the lesion causing PND. 3,9,10 Their paramount concern is leaving atypia or carcinoma behind, particularly as surgical disruption of central ducts eliminates further PND and offers a false sense of security for patient and surgeon. The results of surgery for PND are often disappointing. Studies report high rates of fibrocystic change and duct ectasia, 1,5-7,9-11 both of which have been questioned as legitimate causes of PND. 5,10These considerations led us to develop a new technique using ultrasonography for the diagnosis and treatment of PND. Our preferred method of evaluating PND has been through ultrasonographic detection, localization, and excision of an intraductal mass.When ultrasound fails to identify this finding, presumably because of the small size or echogenicity of the lesion, we have often detected focal ductal dilatation (FDD) in the axis correlating with the site of PND. We hypothesized that FDD is a radiographic manifestation of the lesion itself and that ultrasound-guided wire localization of this finding would enable identification and excision of the causative lesion. We describe our experience to date with this technique.--

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Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge

Cited by 94 publications

References 25 publications

Management of Nipple Discharge and the Associated Imaging Findings

Management of Nipple Discharge and the Associated Imaging Findings

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

Ultrasound-guided wire localization of focal ductal dilatation in the evaluation and treatment of pathologic nipple discharge

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