Ductogram (Galactogram) Diagnosing Nipple Discharge

Breast Ducts and Lobes in Cross Section View
Breast Ducts and Lobes in Cross Section View. Illustration © Pam Stephan

Ductogram - Imaging for Breast Ducts:

A ductogram (also called a galactogram) is used to view your breast ducts and is helpful in diagnosing nipple discharge, ductal ectasia, fibrocystic changes, intraductal papillomas and breast cancer. Having a ductogram can accurately guide your surgeon to the ducts that may need to be removed, in case of ductal carcinoma or intraductal papillomas.

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. Ductography is a very specialized procedure and isn't available everywhere. A highly trained and experienced radiologist should do this procedure.

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. Color and thickness 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 would throw off the resulting image.

A Familiar Feeling:

You may be wondering what this will feel like – and if you've ever breastfed, you will have a familiar feeling. A duct full of contrast agent will feel like a duct full of breast milk before the baby has been fed. On the other hand, 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 less than the usual pressure will be applied 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.

Sources: American Cancer Society. Overview: Breast Cancer. If Breast Cancer Is Suspected. Revised: 09/26/2007.

Radiographics. 2001;21:133-150. Ductography: How To and What If? S. Horatio Slawson, MD and Bradley A. Johnson, MD.

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