Rationale and Objectives
To propose grid coordinate marker placement for patients with suspicious ductogram findings occult on routine workup. To compare the success of marker placement and wire localization (WL) with ductogram-guided WL.
Materials and Methods
A retrospective search of radiology records identified all patients referred for ductography between January 2001 and May 2008. Results for 16 patients referred for ductogram-guided WL and 5 patients with grid coordinate marker placement at the time of ductography and subsequent WL were reviewed. Surgical pathology results and clinical follow-up were reviewed for concordance.
Results
Nine of 16 patients (56.3%) underwent successful ductogram-guided WL. Eight of nine patients had papillomas, one of which also had atypical ductal hyperplasia (ADH). One of nine patients had ectatic ducts with inspisated debris. Seven patients who failed ductogram-guided WL eventually underwent open surgical biopsy. Four of seven patients had papillomas, one of which also had lobular carcinoma in situ. Remaining patients had ADH (1/7) and fibrocystic changes with chronic inflammation (3/7). All five (100%) patients with grid coordinate marker placement underwent successful WL and marker excision. Pathology results included three papillomas, papillary intraductal hyperplasia, and fibrocystic change.
Conclusion
Grid coordinate marker placement at the time of abnormal ductogram provided an accurate method of localizing ductal abnormalities that are occult on routine workup, thus facilitating future WL. Marker placement obviated the need for repeat ductogram on the day of surgery and ensured surgical removal of the ductogram abnormality.
Nipple discharge is a common clinical symptom among patients presenting for diagnostic mam-mography. Although the most common cause of spontaneous nipple discharge is a solitary papilloma , approximately 10–15 % of spontaneous nipple discharge may be attributable to breast cancer . Pathologic nipple discharge is generally defined as spontaneous, unilateral single duct discharge consisting of clear, serous, serosan-guinous, or bloody fluid . Although the prevalence of cancer may be low, nipple discharge may be the only clinical symptom .
According to National Comprehensive Cancer Network (NCCN) guidelines , the standard workup for nipple discharge includes a clinical history to determine whether the discharge is pathologic and directed physical examination to evaluate for a palpable abnormality. If the nipple discharge is judged to be pathologic, a mammogram and possible ultrasound are recommended. Should imaging findings be benign, a ductogram is considered optional. Biopsy is recommended for suspicious imaging or clinical findings. Subareolar duct excision is the gold standard of care.
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Materials and methods
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Ductogram Technique
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Ductogram-guided Marker Placement
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Results
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Ductogram-guided Wire Localization
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Marker Placement at Time of Ductogram
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Discussion
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