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Ductography

A ductography is an X-ray exam that allows a radiologist to get pictures from inside the breast’s milk ducts. This is typically done to evaluate a patient who has bloody or clear nipple discharge and an otherwise normal mammogram.

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Answers to Your Ductography Questions

Ductography, also known as galactography, is an X-ray exam that uses mammography and a contrast material to obtain pictures, called galactograms, from inside the breast’s milk ducts.

The breast is composed primarily of three structures: fat; lobules, which make milk; and milk ducts that carry the milk from the lobule to the nipple. While mammography, ultrasound and MRI are excellent ways to get an image of the breast, they do not show the inside of the breast’s milk ducts as well as ductography.

The most common use of a ductography is to evaluate a patient who has bloody or clear nipple discharge and an otherwise normal mammogram.

Ductography is typically NOT used in women with the following conditions: 

  • A nipple discharge that is milky, yellow, green, black or gray. 

  • Discharge from both breasts in a woman who has not had children. This may indicate a side effect from a drug or may be related to a pituitary problem located in the brain.

In a ductography, a small amount of contrast material is injected into the milk duct, and a mammogram is performed so that the inside of the milk duct can be seen.

If the contrast doesn’t fill the milk duct properly (called a filling defect), it often indicates a small mass. Most of these are papillomas, which are noncancerous masses in the milk ducts. They may be precancerous and sometimes are removed. Less than 10% of filling defects will be cancerous.

In some cases, no filling defects will be identified, but the ducts lead to cysts in the breast. This fibrocystic change may cause a bloody discharge, which is not harmful.

This exam is usually done in an outpatient setting. The patient is seated or placed on her back with the breast exposed. The nipple is cleaned, and a tiny amount of fluid is squeezed from the nipple to identify the duct with the discharge. The milk duct may be dilated to allow a small hollow tube, called a catheter, to be inserted into the milk duct. Occasionally a warm towel will be placed on the breast to help the milk duct become more visible and to allow easier access to the duct. A small amount of contrast material is then injected and a mammogram is obtained. A second injection and mammogram may be performed, if necessary.

You should hold very still and may be asked to hold your breath for a few seconds while the X-ray picture is taken. This will reduce the possibility of a blurred image.

When the exam is complete, you will be asked to wait until the radiologist determines that all of the necessary images have been taken. The procedure usually takes between 30 minutes and an hour.

On the day of your ductography: 

  • Do not squeeze the nipple prior to the exam, as sometimes there is only a small amount of fluid, and it’s necessary to see where the fluid is coming from to perform the exam. 

  • Do not wear deodorant, talcum powder or lotion under your arms or on your breasts. 

  • Inform your physician of any medications you are taking and if you have any allergies, especially to iodinated contrast materials. 

  • Wear a two-piece outfit, as you will be asked to remove all clothing and jewelry above the waist.

A radiologist who is trained to supervise and interpret radiology exams will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you. A report may also be given directly to you at the time of the exam.

Sometimes, follow-up examinations may be necessary. A follow-up exam could more closely look at a suspicious spot or finding. Follow-up exams are also sometimes the best way to see if treatment is working or if an abnormality is stable over time.

  • Ductography can find small cancerous and noncancerous masses that can’t be identified in any other way.

  • A ductography can identify the location of a tumor in the breast for a surgeon.

  • It is possible to injure a duct, either during the process of placing the catheter or while injecting contrast material. This usually heals by itself.

  • There is always the possibility of infection of the breast, or mastitis, but this is uncommon.

  • If there is no discharge at the time of the exam, the duct with the discharge cannot be identified, and the test cannot be performed. 

  • Some ducts are quite small and may not dilate. If the wrong duct is injected, an incorrect diagnosis can be made. 

  • Not all breast tumors occur within the ducts, and a tumor may be present that is not identified on the ductography.

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