Galactography or ductography may be used to evaluate patients presenting with spontaneous isolated bloody or clear nipple discharge. Numerous studies document a 10 to 15 percent incidence of carcinoma in women with spontaneous unilateral discharge from a single duct.27-29 The incidence of carcinoma in patients with bloody versus serous discharge is similar.27 Other types of discharge, including green, yellow, or milky discharges, have not been associated with carcinoma.12

Galactography is not indicated in pregnant or lactating women or when the discharge occurs from multiple bilateral ducts. Galactography

Figure 3-25. Extensive intraductal component. Calcifications within a tumor mass and extention into surrounding tissue.
Herrera Nipple Discharge
Figure 3-26. Galactographic image demonstrating the abrupt duct termination due to an intraductal filling defect (arrow), in this case, a benign intraductal papilloma.

should not be performed on a patient with active mastitis because it may worsen the inflammation.

Evaluation of women with bloody or serous nipple discharge should begin with mammogra-phy. If the mammogram is unrevealing, ductog-raphy can be performed by painlessly cannulat-ing the discharging duct and gently injecting radiographic contrast material. Postinjection mammographic images reveal intraductal filling defects or abrupt duct termination when pathology is present (Figure 3-26). The benign intraductal papilloma is the most common cause of spontaneous serosanguinous nipple discharge. Benign duct ectasia may also cause nipple discharge.

Prior to surgical excision of the ductal lesion, preoperative galactography can be performed with a mixture of iodinated contrast material and methylene blue dye to enable intraoperative localization of the involved duct. It has been suggested that this technique can allow a more accurate and limited resection.27

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