Ductography of the breast: technique and findings

The evaluation of spontaneous nipple discharge is controversial. Many surgeons advocate major subareolar duct excision for postmenopausal patients or solitary duct excision for premenopausal women with this symptom, without preoperative diagnostic imaging. There is no dispute that as a symptom, nipple discharge can be eliminated by severing the major subareolar ducts. However, this decision requires generous assumptions on the part of the surgeons: first, that the abnormal duct can be identified correctly; second, that the segmental area or areas of the breast drained by the duct can be predicted accurately; and third, that the amount of tissue that needs to be excised to ensure inclusion of the lesion or lesions can be defined. Ductography can show the course of abnormal ducts, as well as the variability in location and extent of intraductal lesions. Preoperative mapping of the abnormal duct can expedite surgery, facilitate accurate minimal-volume breast biopsies, and alert the surgeon to the existence of an extensive ductal lesion or multiple lesions. In patients with fibrocystic changes or duct ectasia on ductography, surgery might be averted altogether. In an effort to demonstrate the usefulness of ductography and encourage its increased use, we review the technique and illustrate normal and abnormal findings.