RadteraGalactography / Ductography
Mammo+ ContrastBreast
Indications
- Spontaneous, single-duct, unilateral nipple discharge (especially serous, serosanguineous, or bloody)
- Localize and characterize intraductal lesion (e.g., papilloma) causing discharge
- NOT indicated for multiple-duct, bilateral, or milky physiologic discharge
Patient prep
- No deodorant/powder/lotion
- Do not express discharge before exam — discharge helps identify the offending duct orifice
- Explain procedure; patient may report discomfort during cannulation/injection
Contrast
AgentWater-soluble iodinated contrast (low osmolar)
RouteIntraductal (cannulation of discharging duct via nipple)
Dose~0.1-1.0 mL (instill until patient feels fullness; avoid overfilling/extravasation)
TimingImage immediately after cannulation while contrast fills the duct
Technique
- Identify the discharging duct orifice; gently dilate and cannulate with a blunt 30-gauge sialography/ductography cannula
- Slowly inject contrast until mild fullness; stop if pain or resistance (risk of extravasation)
- Acquire magnification CC and ML/MLO views with the cannula in place
- Often combined with DBT-galactography or followed by MRI/US; many centers now favor MRI for ductal pathology
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Magnification CC | Craniocaudal | Ductal filling; look for filling defect, cutoff, irregularity |
| 2 | Magnification ML/MLO | Lateral / oblique | Orthogonal localization of intraductal lesion |
Key points
- Findings suggesting pathology: intraluminal filling defect, abrupt ductal cutoff/obstruction, irregular wall, ductal distortion
- Single discharging duct is the key selection criterion; physiologic multi-duct/bilateral discharge is not an indication
- Air bubbles can mimic filling defects — avoid introducing air
- Localizes lesion to guide excision (duct excision/microdochectomy); MR ductography is an alternative
References
• ACR Appropriateness Criteria: Evaluation of Nipple Discharge - 2022 Update (JACR 2022)
• Radiopaedia: Breast ductography ( link
• Slawson SH, Johnson BA. Ductography: How To and What If? RadioGraphics. 2001;21(1):133-150. — and — Yücesoy C, Öztürk E, Özer Y, Edgüer T, Hekimoglu B. Conventional Galactography and MR Contrast Galactography for Diagnosing Nipple Discharge: Preliminary Results. Korean J Radiol. 2008;9(5):426-431. https://doi.org/10.3348/kjr.2008.9.5.426 link
• Radiopaedia: Breast ductography ( link
• Slawson SH, Johnson BA. Ductography: How To and What If? RadioGraphics. 2001;21(1):133-150. — and — Yücesoy C, Öztürk E, Özer Y, Edgüer T, Hekimoglu B. Conventional Galactography and MR Contrast Galactography for Diagnosing Nipple Discharge: Preliminary Results. Korean J Radiol. 2008;9(5):426-431. https://doi.org/10.3348/kjr.2008.9.5.426 link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.