Galactography: an important and highly effective procedure
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Galactography should only be performed if there is spontaneous bloody or serous discharge from a single lactiferous duct of one breast. If this is observed, only pathologic processes instead of normal breast tissue are removed upon surgery and there is a close correlation between radiologic results and pathologic findings. Galactography localizes intraductal pathologic processes precisely and thus contributes to minimal volume surgery.
Keywords.Galactography Papilloma Ectatic duct Carcinoma
Opacification of lactiferous ducts with non-ionic contrast agent is called galactography [1, 2, 3]. Galactography is performed as an extension of mammography when nipple discharge is present. It is the only diagnostic procedure that is able to depict and precisely localize small intraductal pathologic processes. There are basically two types of normal lactiferous systems: one that shows repetitive arborization extending deeply into the breast tissue with tapered ends, and one with only short side arms extending from the main duct and showing blunt ends [4, 5]. There are numerous characteristic pathological findings in galactography . The most common finding is papilloma followed by ectatic ducts and a combination of both. The least common finding is carcinoma of the breast [6, 7].
Nipple discharge is a common problem in women and demands proper attention by the gynecologist as well as the radiologist. It is the radiologist's responsibility to perform a galactography under strict consideration of the indication for that exam. It should only be performed if there is spontaneous serous or bloody discharge from a single duct of one breast [6, 7, 8, 9, 10]. This makes sure that upon surgery pathology – and not normal breast tissue – is removed. Discharge that only occurs upon applying pressure to the breast or the nipple and discharge from more than one lactiferous duct usually is not caused by a local process; thus, the problem cannot be solved by a local diagnostic and/or surgical procedure.
Spontaneous nipple discharge from one duct, serous or bloody, is caused by papilloma, ectatic duct, or carcinoma of the breast . All three conditions are local entities. Papilloma and ectatic ducts almost never show a recognizable change in mammography [11, 12] and there are numerous carcinomas spreading confined to the duct that are not visible on mammograms. In these cases galactography is the only procedure that can characterize and precisely localize the lesion so that it can be surgically removed with a small volume of tissue [6, 12, 13, 14, 15]. Other methods of localization, such as injection of blue dye into the duct, is not precise enough because the dye quickly diffuses into the surrounding tissue. Resection within a small volume of tissue is of particular importance for the benign lesions .
Galactography should only be performed in patients with spontaneous serous or bloody discharge from a single lactiferous duct of one breast. If this rule is followed, galactography yields excellent results with high diagnostic efficiency and very good correlation to pathology. It thus contributes substantially to the surgical approach in that it localizes lesions very precisely. Consequently, both benign and malignant lesions can be removed with the smallest possible tissue volume leaving the woman with only a small defect. In the case of diffusely spreading carcinoma, galactography is able to depict the extent of spreading more than any other method so that preoperative planning is facilitated.
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