From the Guidelines
Ductiform contrast, also known as galactography or ductography, is a valuable diagnostic tool for evaluating patients with pathologic nipple discharge, particularly when the discharge is spontaneous, unilateral, and from a single duct, as it can detect abnormalities not visible on standard mammography or ultrasound, with a reported sensitivity of 75% to 100% for detecting cancer and high-risk lesions 1.
Key Points to Consider
- The procedure involves injecting a small amount of contrast material into a milk duct through the nipple opening, followed by a mammogram to visualize the ductal system.
- Ductography has the ability to demonstrate very small lesions in the specific duct that is secreting the pathologic nipple discharge, but it is invasive and may cause discomfort and pain, with a reported rate of incomplete ductography as high as 15% 1.
- Findings on ductogram suggestive of malignant or papillary lesions include intraductal filling defect, partial or complete obstruction of a duct, duct expansion or distortion, and duct wall irregularity 1.
- The primary value of ductography is not to determine whether surgery is indicated but to locate the precise site of the intraductal lesions to aid in the choice of appropriate surgery, with a reported ability to localize 76% of otherwise occult malignant/high-risk lesions and 91% of benign lesions in patients with negative standard evaluations 1.
Important Considerations
- Ductography is not recommended in lactating women or patients with active mastitis, and known hypersensitivity to iodinated contrast agents is a relative contraindication 1.
- The procedure typically takes about 30 minutes and may cause mild discomfort but is generally well-tolerated.
- The use of ductography should be considered on a case-by-case basis, taking into account the patient's symptoms, medical history, and the results of other diagnostic tests, as it can provide valuable information to guide surgical intervention when necessary 1.
From the Research
Ductiform Contrast
- The term "ductiform contrast" is not explicitly defined in the provided studies, but we can explore the concept of contrast agents and their properties.
- Contrast agents, such as iodixanol and iopamidol, are used in medical imaging to enhance the visibility of structures or lesions 2, 3.
- The osmolality of contrast agents, such as iodixanol (290 mOsm/kg) and iopamidol (796 mOsm/kg), can affect their nephrotoxicity in patients with chronic kidney disease 2.
- Studies have compared the effects of different contrast agents on renal function, with some suggesting that iodixanol may be less nephrotoxic than other nonionic contrast agents in renally impaired patients 2, 4.
- The cost-effectiveness of contrast agents, such as iodixanol and iohexol, has also been evaluated, with iodixanol appearing to be cost-effective in patients at high risk of contrast-induced nephropathy 4.
- Other studies have explored the use of contrast agents, such as iopamidol, as responsive MRI-chemical exchange saturation transfer contrast agents for pH mapping of kidneys 3.
- The selection of a contrast agent should consider factors such as safety, cost, and properties like osmolality, ionicity, viscosity, and direct chemotoxicity 5.