Article-9 97


 

A 38-year-old lady presented to the Ibn Sina Breast 

Care Centre, Dhaka with the complaints of bloody 

discharge through the left breast nipple. On 

examination, there was spontaneous bloody 

discharge from left breast nipple through a single 

duct. There was no mass on palpation. She was then 

referred for ultrasonography and ductography of the 

left breast. USG showed multiple cysts, however no 

intracystic solid portion could be noted. Ductography 

revealed dilated duct with contrast agent filling 

defects approximately 2.9 cm from the nipple and 

sudden cut-off of the contrast column about 3.7 cm 

from the nipple. Findings are consistent with 

intraductal papilloma with duct ectasia.

Fig 1. Galactography of left breast

Abnormal nipple discharge is associated with an 

underlying malignancy in 1.2% to 15% of patients.1 

Abnormal discharge is defined as nonlactational, 

persistent, spontaneous, and unilateral.2  Bloody or 

hemoccult-positive discharge is more likely to be 

associated with cancer (5% to 28%) and should 

prompt further evaluation.3 However, clear or watery 

discharge has been associated with breast cancer in 

up to 7% of cases.1 Mammography is advocated as 

part of the routine evaluation of women with breast 

complaints. Mammography is associated with a 9.5% 

false-negative rate and a 1.6% false-positive rate in 

detecting breast cancer in patients with nipple 

discharge.4 Ductography is an increasingly available 

method of examination and is relatively easy to 

perform with few complications. Ductography has 

been shown to be accurate in providing the location 

and depth of ductal abnormalities when a single duct 

is identified as the source.1 Data regarding the 

location of the lesion greatly facilitate biopsy, 

especially with deep lesions. Ductography has also 

been shown to improve the diagnostic yield of 

surgical biopsy from 67% in nonstudied patients to 

100% in patients receiving a ductogram.5

Sharmin Akhtar Rupa 

Associate Professor

Department of Radiology & Imaging

Enam Medical College & Hospital, Savar, Dhaka 

Email: dr.sharminakhtarrupa@yahoo.com

Mahbooba Ishrat

Medical Officer

Ibn Sina Breast Care Centre, Dhaka

 

Sonia Shahid

Medical Officer

Ibn Sina Breast Care Centre, Dhaka

References

1.  Tabar L, Dean PB, Pentek Z. Galactography: the diagnostic 

procedure of choice for nipple discharge. Radiology 

1983; 149: 31–38. 

2.  Fiorica JV. Breast disease. Curr Opin Obstet Gynecol 

1992; 4: 897–903. 

3.  Chaudary MA, Millis RR, Davies GC, Hayward JL. The 

diagnostic value of testing for occult blood. Ann Surg 

1982; 196: 651–655.

4.  Fiorica JV. Nipple discharge. Obstet Gynecol Clin North 

Am 1994; 21: 453–460. 

5.  Van Zee KJ, Ortega Perez G, Minnard E, Cohen MA. 

Preoperative galactography increases the diagnostic yield 

of major duct excision for nipple discharge. Cancer 1998; 

82: 1874–1880.

 

97

Ductography: The Diagnostic Procedure of Choice in

Patients with Abnormal Nipple Discharge

Images in Clinical Medicine