Ductography

醫事放射師 ： 蕭珮琳醫事放射師 ： 蕭珮琳

What is Ductography?

Ductography is an X ray examination Ductography is an X ray examination that uses mammography, and a contrast that uses mammography, and a contrast material to obtain pictures, of the inside material to obtain pictures, of the inside of the breast's milk ducts , also called of the breast's milk ducts , also called galactograms .galactograms .

Purpose

A ductogram is a mammographic procedure A ductogram is a mammographic procedure that is performed to help identify an that is performed to help identify an abnormality in the breast duct that may be the abnormality in the breast duct that may be the source of nipple discharge and is valuable in source of nipple discharge and is valuable in diagnosing intraductal papillomas and other diagnosing intraductal papillomas and other conditions. Papillomas are wart-like, non-conditions. Papillomas are wart-like, non-cancerous tumors with branchings or stalks cancerous tumors with branchings or stalks that have grown inside the breast duct; they are that have grown inside the breast duct; they are the most common cause of nipple discharge. the most common cause of nipple discharge.

Anatomy

The breast is composed primarily of The breast is composed primarily of

three structures: three structures: FatFat LobulesLobules (that make the milk) (that make the milk) Milk ductsMilk ducts (that carry the milk from the (that carry the milk from the

lobule to the nipple) lobule to the nipple)

Anatomy

正常乳腺年輕女性乳腺　　　　　　　　　　懷孕女性　

脂肪組織乳腺組織

結締組織

皮膚皮下脂肪織

Cooper 靭帯

大胸筋

乳頭開口部

乳管洞

乳管

小葉

乳腺後脂肪織

乳腺内

乳腺的解剖

小葉

5-6 個小葉 :Terminal duct lobular unit

Indication

unilateral, single-pore spontaneous nipple discharge

•multicolored/sticky, purulent, clear/watery,

yellow/serous , pink/ serosanguineous ,

bloody /sanguineous

Causes of Nipple Discharge

Intraductal papillomaIntraductal papilloma DuctectasiaDuctectasia Breast CancerBreast Cancer Pituitary tumorPituitary tumor DrugDrug

Bilateral nipple discharge

DrugDrug Pituitary tumor ( >1000mU/L )Pituitary tumor ( >1000mU/L )

- - milklymilkly

Contraindication

– Severe allergy to iodinated contrast material

– Severe nipple retraction – a history of prior nipple surgery that

would completely disconnect the

nipple pores from the underlying ducts

prepare

NPO 4 hoursNPO 4 hours The nipple not be squeezed prior to the The nipple not be squeezed prior to the

examexam Do not wear deodorant, talcum powder Do not wear deodorant, talcum powder

or lotion under your arms or on your or lotion under your arms or on your breastsbreasts

material

contrast material : water (1:1) Sialography set Sialography set （（ small cathetera plastic small cathetera plastic

hollow tube , blunt-tipped needle hollow tube , blunt-tipped needle ））

Procedure

Slowly administer 0.2–0.3 mL of contrast material

normal

Normal Ductal System

1.Lactiferous duct 2.Segmental branch 3.Subsegmental

branch 4.Peripheral

branches 5.Termainal duct

unit

case

Ductal Ectasia

Craniocaudal ductogram shows a dilated ductal system.

Ductography demonstrates ductal ectasia and no other abnormality

Intraductal Papilloma

papilloma

Multiple microcalcifications

Cancer

Treatment

Preoperative ductography with a 1:1 solution of contrast material and methylene blue allows identification of the abnormal duct for mammography and for the operating surgeon

Standard central duct excision results in resectionof a cone of tissue approximately 4–5 cm in length directly posterior to the nipple

failure

Extravasation

Experience focal pain or burning, although the

process may be completely asymptomatic Administer too much contrast material,

resulting in extravasation in their first few procedures

Wall perforation by vigorous cannula insertion Rarely, destruction of ductal integrity by

carcinoma leads to extravasation

the cannula within a papilloma (arrow). Note the reflux of contrast material to the surface.

The cannula may pierce solid intraluminal

masses, even without pressure, or slide

between a mass and the side wall of the duct

Obstruction and Reflux

Artifacts

Air bubble --from the cannula , syringe, and extension tubing

Silicone or saline augmentation implants direct silicone injections

Failure or contrast medium extravastion –

reschedule it for 7-14 days

discussion

Nipple discharge can be caused by non-cancerous tumors such as papillomas, or cancer such as ductal carcinoma in situ (DCIS). However, the majority of nipple discharges are due to benign (non-cancerous) causes.

10~15% cancer ( discharge could be only sign) Galactography can find small cancerous and

non-cancerous tumors that cannot be identified in any other way so that they may be removed at an early stage.