Ductography (Galactography)

Ductography is an X-ray examination that uses mammography—a low-dose X-ray system for examining breasts—and a contrast material (X-ray dye) to obtain pictures, called galactograms, of the inside of the breast’s milk ducts.

The breast is composed primarily of three structures: fat, lobules (which make the milk) and milk ducts (which carry the milk from the lobule to the nipple). While mammography, ultrasound and magnetic resonance imaging (MRI) are excellent ways to image the breast, they do not visualize the inside of the breast’s milk ducts to the same degree as ductography. Ductography is used to evaluate a woman who has a bloody or clear nipple discharge and an otherwise normal mammogram.

Ductography is typically NOT called for in women with the following conditions:

  • A discharge that is milky, yellow, green, black or gray, which is usually not a cause for concern, especially if it comes from multiple ducts in the breast.
  • A discharge that is from both breasts in a woman who has not had children, which may indicate a side effect from a drug or may be related to a pituitary problem located in the brain.

How Should I Prepare?
Very little preparation is necessary for this procedure. The only requirement is that the nipple not be squeezed prior to the exam, as sometimes there is only a small amount of fluid and it is necessary to see where that fluid is coming from to perform the exam.

Inform your physician of:

  • Any medications you are taking.
  • Any allergies, especially to barium or iodinated contrast materials.
  • Recent illnesses or other medical conditions.
  • If there is any possibility that you are pregnant.

As in mammography, do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots. In addition, you will be asked to remove all jewelry and clothing above the waist before the examination and will be given a gown that opens in the front.

How Does the Procedure Work?
In ductography, a small amount of contrast material (X-ray dye) is injected into the milk duct, and a mammogram is performed so that the inside of the milk duct can be seen. If there is a filling defect in the milk duct, it often indicates a small mass. Most of these are papillomas, which are non-cancerous masses of the milk ducts. They may be pre-cancerous, and sometimes are removed. Less than 10% of filling defects are cancerous.

The ductogram will not only find the small mass, but will also show where it is located in the breast to help the surgeon find the area. In some cases, there are no filling defects. Rather, the ducts lead to cysts in the breast, a sign of fibrocystic changes. These cysts may cause a bloody discharge but generally are not worrisome.

What Will I Experience During and After the Procedure?
The dilation of the milk duct can sometimes be uncomfortable; however, it is usually not painful. The nipple may be squeezed to identify the milk duct with the discharge.

What are the Benefits and Risks
Benefits

  • Ductography can find small cancerous and non-cancerous masses that cannot be identified in any other way so that they may be removed at an early stage.
  • A ductogram identifies the location of the tumors in the breast for the surgeon.

Risks

  • It is possible to injure the duct, either during the process of placing the catheter or while injecting contrast material (X-ray dye). This usually heals by itself.
  • There is always a possibility of infection of the breast (mastitis), but this is uncommon.

Who Interprets the Results and How Do I Get Them?
Our board-certified radiologists will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Gwinnett Medical Center Imaging has multiple convenient Atlanta-area locations in Lawrenceville, Hamilton Mill and Duluth. If you would like to schedule an appointment, please call 678-312-3444.