Preoperative galactography increases the diagnostic yield of major duct excision for nipple discharge

• Published in: Cancer Vol. 82; no. 10; pp. 1874 - 1880
• Main Authors: Zee, Kimberly J. Van, Pérez, Gloria Ortega, Minnard, Emery, Cohen, Michael A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York John Wiley & Sons, Inc 15.05.1998; Wiley-Liss
• Subjects: Adult; Aged; Biological and medical sciences; Breast; breast carcinoma; Breast Diseases - diagnostic imaging; Breast Diseases - surgery; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Breast Neoplasms, Male - diagnostic imaging; Breast Neoplasms, Male - surgery; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - surgery; contrast mammography; Contrast Media; diagnosis; ductogram; ductography; Exudates and Transudates; Female; galactogram; Genital system. Mammary gland; Humans; Investigative techniques, diagnostic techniques (general aspects); major duct excision; Male; Mammography - methods; Medical sciences; Middle Aged; nipple discharge; Nipples - metabolism; papilloma; Papilloma - diagnostic imaging; Papilloma - surgery; Predictive Value of Tests; Preoperative Care - methods; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; surgery; Human; Mammary gland diseases; Radiodiagnosis; Etiology; Nipple discharge; Medical imagery; Galactography; Diagnosis; Preoperative
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19980515)82:10<1874::AID-CNCR9>3.0.CO;2-N

BACKGROUND Although most nipple discharge is due to a benign etiology, approximately 10‐15% is due to breast carcinoma. The standard management of nipple discharge includes major duct excision, and although this procedure may eliminate future nipple discharge, a specific etiology is not always found. This study investigates the utility of preoperative galactography in targeting the causative lesion. METHODS During 1994‐1996, 46 cases of major duct excision were identified from operating room records. All patients presented with spontaneous nipple discharge from a single duct. In 16 patients both a diagnostic galactogram and a preoperative galactogram with methylene blue were performed to localize the causative lesion and to enable intraoperative identification. Data were obtained by retrospective chart review. Statistical significance was determined by Fisher's exact test. RESULTS Preoperative galactography was obtained in 7 of 31 patients (23%) with bloody nipple discharge and 9 of 15 patients (60%) with guaiac negative discharge. All patients undergoing preoperative galactography were found to have either a filling defect and/or duct cutoff (n = 13) or duct ectasia (n = 3). All patients with a filling defect and/or duct cutoff on galactogram were found to have a carcinoma or papilloma at surgery. In the three patients with duct ectasia observed on galactogram, the diagnosis was confirmed at surgery. All patients who underwent preoperative galactography were found to have specific pathology that accounted for the nipple discharge versus 20 of 30 patients (67%) who did not undergo preoperative galactography (P = 0.009). CONCLUSIONS Although major duct excision for nipple discharge may eliminate the presenting symptomatology, a pathologic correlate is not always found. The data from the current study show that localizing the causative lesion by preoperative galactography increases the likelihood that specific pathology will be found at surgery, and suggests that preoperative galactography may be helpful in the evaluation and management of patients presenting with spontaneous nipple discharge. Cancer 1998;82:1874‐80. © 1998 American Cancer Society. In the evaluation of nipple discharge, localization of the causative lesion by preoperative galactography increased the likelihood that the causative pathology was found at surgery from 67% to 100% (P = 0.009).