A ductogram is used to identify the cause of spontaneous nipple discharge. Because nipple discharge can be caused by many factors, ductography is used to screen for diseases ranging from carcinoma to ductal ectasia and papilloma.
This special procedure introduces contrast material to a breast milk duct to allow the radiologist to examine the duct using mammography. Using the results of the ductogram, the radiologist may recommend that a surgeon remove suspicious ducts for biopsy.
For this procedure, the patient rests on her back on an examination table. The radiologist will first find the ‘trigger point’ of the nipple leakage, to identify the pore in which to administer the ductogram. The area of the discharge is cleansed with antiseptic. The radiologist will then use a test strip to sample the discharge for the presence of blood. With a small device called a cannula, a few drops (0.2 mL - 0.3 mL) of contrast material are administered into the duct. No harmful side effects of the contrast material used in this procedure have been found. Next, tape will be placed around the point of entry to stabilize the cannula in preparation for the gentile mammogram.
The radiologist will carefully exam the breast using mammography equipment. The contrast material applied in the ductogram allows the radiologist to examine the internal structure of the breast’s duct using X-ray technology. Additional small amounts of contrast material may be administered to obtain a better view of the complete structure of the breast duct, if necessary.
When the procedure is complete, the tape is removed from the breast and a pad is provided to minimize any discharge. The results of the ductogram will be discussed with the patient and the radiologist may recommend a follow-up ductogram in 2-4 weeks to confirm the results of the procedure.
Patients showing signs of ductal ectasia and fibrocycstic changes will be recommended to return for short-term follow-up, and surgical options may be discussed. Patients exhibiting signs of carcinoma or history of breast cancer or suspicious discharge are often recommended for surgical duct removal.
Before biopsy, a pre-surgery ductogram may be performed to ensure the surgeon wholly removes the suspicious breast duct.