Ductogram (Galactogram) Diagnosing Nipple Discharge

breast ducts and lobes in cross section view
What is a ductogram and what happens during the procedure? What conditions may be diagnosed?. Illustration © Pam Stephan

If your doctor has ordered a ductogram (also called a galactogram) you might be wondering what it is like to have the test and what conditions may be diagnosed. A ductogram is a very specialized procedure that isn't available everywhere, so you may not be familiar with the test.When are these tests ordered and what conditions to they help diagnose? How should you prepare for the test? Is the test uncomfortable?

Let's take a look at all of these questions.

Ductogram - Imaging for Breast Ducts

A ductogram (also called a galactogram) is used to view your breast ducts. It can be helpful in finding the cause of nipple discharge, A ductogram requires that a contrast agent is injected into the breast, like during a breast MRI. A tiny tube (cannula) is used to put fluid into the breast duct, like during ductal lavage. The injected contrast agent allows your milk ducts to show up clearly on a mammogram. Since ductography is a very specialized procedure, a highly trained and experienced radiologist should do this procedure. Research is now looking at the combination of ductography in combination with contrast-enhanced MR with regard to the ability to determine the cause of nipple discharge.

Having a Ductogram

Your ductogram will be done while you're having nipple discharge. This helps your radiologist find the specific duct that is leaking.

Only the duct that is discharging fluid will be tested during your imaging study.

What to Wear to a Ductogram

On the day of your ductogram, don’t use talcum powder, deodorant or skin lotion. These can interfere with the imaging results. Dress for comfort, as you will be asked to remove all your clothing from the waist up.

Choose a loose top that is easy to remove and replace. If you can, avoid wearing an underwire bra, since you will be having a mammogram with compression as part of this exam. Your breast may be a bit sore after the exam, and a soft-cup bra will feel more comfortable than a wired bra.

Getting Started With Your Ductogram

In an exam room, you will lie down on the table and uncover the breast that has the nipple discharge. Your nipple will be cleaned and sterilized so that it's easier to find the duct that is leaking. Next, your doctor will press on your breast, to find the trigger zone. The trigger zone is the area that will consistently cause nipple discharge when pressure is applied. If your ducts will be surgically removed, this trigger zone will be helpful to your surgeon.

Testing Your Nipple Discharge

A sample of your discharge fluid will be taken and tested. The color and thickness if the discharge will be noted, and a test strip may be used to test for blood. Bloody discharge is associated with intraductal papillomas, ductal ectasia, cystic disease and breast cancer.

Inserting the Tube and Contrast Agent

Once the duct has been identified and the nipple discharge sampled, your doctor will use magnifying glasses to see the specific duct.

A very small and flexible tube, called a cannula, will be gently inserted right into this duct in your nipple. Gentle pressure will be used, and should not produce any pain, but if it does, you should let your doctor know. The tube will be taped in place, and then connected to a small syringe filled with contrast agent. This will be slowly injected into your milk duct. Your doctor will take care to avoid air bubbles in the tube, as that could make the resulting image less accurate.

What Does a Ductogram Feel Like?

You may be wondering what a ductogram will feel like. The feeling is easier to describe for those have breastfed in the past, in which case you may have the sensation you had when your milk "let down." A duct full of contrast agent will feel like a duct full of breast milk before the baby has been fed.

Certainly, when your breasts became overfull between feelings, you may remember some discomfort, and you may note this feeling as well. If your nipple starts to hurt, or the pressure inside your duct is painful, there are several things your doctor can do to help. Anesthetic gel or warm compresses can be applied to make you more comfortable. Your doctor doesn't want to cause you pain, and if you are tense, it can delay or prevent the exam from proceeding. Speak up if you're feeling pain!

Getting the Ductogram Image

With the tube still in place, your doctor may use an ultrasound machine to see if enough contrast fluid has been injected. When your duct is full enough, you can proceed to the mammogram machine for the imaging. Some doctors will remove the tube and put tape over your nipple, to keep the contrast agent inside your duct, and some doctors will leave the tube in position. Your breast will be positioned as for a mammogram, and pressure will be applied (but less pressure than with a regular mammogram) while the image is taken. If air bubbles or the tube is in the way of the image, other angles may be taken.

Getting Results from Your Ductogram

Your radiologist will carefully study the images from your ductogram and write a report on the results. Your doctor or radiologist will contact you about the results, giving you a diagnosis and recommendation for follow-up. If you are having surgery to remove the ducts or nearby tissue, a preoperative ductogram may be done, with the addition of blue dye (similar to a sentinel node biopsy), to help your surgeon see the duct which must be removed.

Conditions That Can be Diagnosed with a Ductogram

Several abnormal conditions involving the milk ducts which may be diagnosed with the help of a ductogram include:

  • Ductal ectasia
  • Fibrocystic changes
  • Intraductal papillomas
  • Breast cancer

In addition to finding the cause of your nipple discharge, having a ductogram can help direct your surgeon to the ducts which need to be removed, for example, during surgery for intraductal papillomas or ductal carcinoma (breast cancer.)

In addition, for those with intraductal carcinoma in situ (DCIS.) intraductal therapy by way of a ductogram may offer a less invasive method of preventing the development of an invasive cancer while minimizing trauma to the breast.

Sources:

Berna-Serna, J., Torres-Ales, C., Berna-Mestre, J., and L. Polo. Role of Galactography in the Early Diagnosis of Breast Cancer. Breast Care. 2013. 8(2):122-6.

Mahoney, M., Gordon, E., Rao, J., Jin, Y., Hylton, N., and S. Love. Intraductal Therapy of Ductal Carcinoma in Situ: A Presurgery Study. Clinical Breast Cancer. 2013. 13(4):280-6.

Nicholson, B., Harvey, J., Patrie, J., and J. Mugler. 3D-MR Ductography and Contrast-Enhanced MR Mammography in Patients with Suspicious Nipple Discharge; A Feasibility Study. Breast Journal. 2015. 21(4):352-62.

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