Adjunctive diagnostic value of ultrasonography evaluation in patients with suspected ductal breast disease

PURPOSE: The purpose of this study was to evaluate the adjunctive diagnostic value of breast ultrasonography (US) in the study of benign ductal breast disease. MATERIALS AND METHODS: Fifty-two patients underwent US examinations for bloody nipple discharge, palpable retroareolar masses, retroareolar opacities or ductal pattern on mammography. US enabled visualisation of mammary-duct ectasia (simple or pseudocystic, retroareolar and/or peripheral) and focal masses (endoluminal or periductal, with ill-defined or regular margins). All patients with nipple discharge underwent cytological evaluation. After the US examination, all focal masses with ill-defined margins underwent fine-needle aspiration biopsy (FNAB), if necessary. The benign alterations were followed up. RESULTS: In 38/52 cases, US diagnosed mammary-duct ectasia and in 30/52 cases, the presence of focal masses (mean size 7 mm). In the nine women who underwent biopsy, histopathological evaluation diagnosed five solitary papillomas, one solitary papilloma with a focal area of ductal carcinoma in situ (DCIS), two multiple papillomas of the nipple and one papillomatosis. CONCLUSIONS: High-frequency US plays an important role in the detection of benign ductal disease both for the diagnosis and classification of focal masses and mammary-duct ectasia. US can be used as a complementary imaging method to galactography or as a valuable alternative when galactography is not available.     

Bloody nipple discharge caused by an intraductal papilloma of the breast in an adolescent girl: A case report

Bloody nipple discharge in pediatric patients is rare and mostly associated with benign conditions.Despite the generally benign nature, a thorough investigation of the cause and treatment is required if a palpable lesion is present. Here, the author reports a case of bloody nipple discharge in an adolescent girl with no significant medical history. Breast ultrasound demonstrated a solid, oval-shaped, circumscribed mass in the left subareolar region that was categorized as category 4a according to the breast imaging reporting and data system (BI-RADS). An excisional biopsy and histological examination confirmed a diagnosis of intraductal papilloma. While intraductal papilloma is rare in the pediatric population, ultrasound evaluation and knowledge of characteristic findings are useful for noninvasive diagnostics and image-guided treatment planning.     

MR imaging in patients with nipple discharge: initial experience

PURPOSE: To investigate the potential of magnetic resonance (MR) imaging in patients with nipple discharge. MATERIALS AND METHODS: Between February 1992 and December 1998, 23 patients with nipple discharge underwent contrast material-enhanced MR imaging at 1.5 T. Mammographic findings were negative in 22 of 23 patients and revealed asymmetry in one patient. Galactography was attempted in two patients, with negative findings in one patient and no success in the other. Fifteen of 23 patients underwent excisional biopsy-seven of 15 with MR imaging-guided localization, and one of 15 with mammographic localization. Eight of 23 patients were followed up clinically (range, 7-24 months; mean, 20 months). RESULTS: In 11 of the 15 (73%) patients who underwent excisional biopsy, MR imaging findings correlated with histopathologic findings. MR imaging demonstrated four of six benign papillomas and one of two fibroadenomas as circumscribed, enhancing subareolar masses. Findings of one MR imaging examination were negative, and benign tissue was found at excisional biopsy. MR imaging findings were suspicious in six of the seven patients with excisional biopsy findings of malignancy (regional enhancement [n = 2], ductal enhancement [n = 2], peripherally enhancing mass [n = 1], and spiculated mass [n = 1]). In one of the seven patients, a benign-appearing intraductal mass was identified at MR imaging; excisional biopsy revealed a benign papilloma with an adjacent focus of DCIS. CONCLUSION: MR imaging can help identify both benign and malignant causes of nipple discharge. It potentially offers a noninvasive alternative to galactography.     

乳腺导管造影诊断乳腺溢液疾病的研究

分析乳腺溢液疾病在乳腺导管造影术中的影像学表现,明确检查之必要性。本组98例乳腺溢液性疾病患者全部同时做普通钼靶摄片及乳腺导管造影摄片,并经临床和病理证实。导管造影表现的分类,无明显异常11例,占11.22%;单纯性导管扩张者14例,占14.29%;导管扩张伴炎症16例,占16.32%;导管扩张伴乳腺增生37例,占37.76%;导管内乳头状瘤16例,占16.33%;导管癌4例,占4.08%。所以乳腺导管造影术检查能够增加溢液性乳腺病的阳性检出率。     

Breast disease in the male: galactographic evaluation

Seven men with unilateral nipple discharge underwent galactography. In two patients the diagnosis was carcinoma, two were benign papillomas, one was a breast abscess, and two were ductal ectasia. Galactography is useful in men and women with nipple discharge, especially when the discharge is bloody and there is no palpable tumor. The precise location of an intraductal lesion through the use of galactography guides the biopsy and makes conservative surgery easier.     

乳导管内视镜检查309例临床影像资料分析

目的评价乳导管内视镜对乳腺导管内疾患的临床诊断价值。方法回顾性分析309例乳头溢液患者纤维乳导管内视镜检查的临床影像资料。结果309例乳头溢液患者中单侧乳头溢液者290例(93.85%),双乳发生溢液者19例(6.15%)。其中乳导管扩张并炎症208侧(63.41%),闭塞性乳导管炎6侧(1.83%),乳导管积乳并炎症2侧(0.61%),单发导管内乳头状瘤70侧(21.34%),多发导管内乳头状瘤23侧(7.02%),乳导管内癌5侧(1.52%),不能除外乳导管内肿瘤或需随访观察14侧(4.27%)。所有导管内单发或多发乳头状瘤、乳导管内癌病例均经手术与病理证实。结论乳导管纤维内视镜对乳导管内病变的诊断具有重要临床价值,对于导管内可疑乳癌可在导管镜指引下行病灶活检手术。     

Pure ductal carcinoma in situ: a range of MRI features

OBJECTIVE: The purpose of this article is to describe and illustrate the variety of common morphologic features, enhancement patterns, and kinetics of pure ductal carcinoma in situ (DCIS) on dynamic contrast-enhanced MRI of the breast, using the American College of Radiology BI-RADS lexicon. CONCLUSION: Breast MRI plays an important role in the detection of DCIS, which most often appears as nonmass clumped enhancement, in a ductal or segmental distribution, with variable enhancement kinetics.     

Role of ultrasonography and MRI in the detection of wide intraductal component of invasive breast cancer--a prospective study

AIM: To compare the role of ultrasound (US) and magnetic resonance imaging (MRI) in the detection of extent and direction of intraductal components around invasive breast cancer in comparison with histopathological findings. MATERIALS AND METHODS: In 60 invasive breast cancers (59 patients), US features of the intraductal components were classified as: (a) solid ductal dilatation radiating from the tumour, (b) the presence of a satellite lesion in the same segment without ductal dilatation, (c) ductal dilatation between the main tumour and the satellite lesion. The criteria for the detection of intraductal components by MRI were as follows: (a) strand-like enhancement on the margin of the main tumour, (b) satellite lesions around the main tumour, or (c) bridging enhancement between the main tumour and the satellite lesion. The direction of the intraductal components was classified as towards the nipple and towards the periphery. RESULTS: Wide intraductal components (>or=15 mm) towards the nipple were proven histopathologically in 17 of 59 (28.8%) cancers, and wide intraductal components towards the periphery were proven histopathologically in three out of 60 (5.0%) cancers. One cancer was located too close to the nipple and it was not possible to measure the intraductal component towards the nipple. US and MRI could accurately detect wide intraductal components towards the nipple in 14 and 8 cancers, respectively, out of 17 cancers. Sensitivity, specificity and accuracy for detection of wide intraductal components towards the nipple by US were 87.5, 88.3, and 88.1%, respectively. Sensitivity, specificity and accuracy for detection of wide intraductal components towards the nipple by MRI were 50, 79.1, and 72.1%, respectively. When the results of both diagnostic methods namely US and MRI were combined, sensitivity rose to 93.7%, specificity was 72.1% and accuracy was 78.0%. CONCLUSION: Although ultrasound is more sensitive than MRI in the delineation of intraductal extension towards the nipple, there is no statistically significant difference in overall accuracy between the two modalities.     

Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcifications

PURPOSE: The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in patients with microcalcifications classed as Breast Imaging Reporting and Data Systems (BI-RADS) 3-5. MATERIALS AND METHODS: Fifty-five patients with mammographic microcalcifications classified as BI-RADS categories 3, 4 or 5 underwent MRI and biopsy with stereotactic vacuum-assisted biopsy (VAB). Our gold standard was microhistology in all cases and histology with histological grading in patients who underwent surgery. Patients with a microhistological diagnosis of benign lesions underwent mammographic follow-up for at least 12 months. MRI was performed with a 1.5-Tesla (T) unit, and T1 coronal three-dimensional (3D) fast low-angle shot sequences were acquired before and after injection of paramagnetic contrast agent (0.1 mmol/kg). MRI findings, according to the Fisher score, were classified into BI-RADS classes. In patients with cancer who underwent surgery, we retrospectively compared the extension of the mammographic and MRI findings with histological extension. RESULTS: Histology revealed 26 ductal in situ cancers (DCIS) and ductal microinvasive cancers (DCmic), three atypical ductal hyperplasias (ADH) and 26 benign conditions. Histological grading of the 26 patients with cancer revealed four cases of G1, 11 cases of G2 and 11 cases of G3. If we consider mammographic BI-RADS category 3 as benign and BI-RADS 4 and 5 as malignant, mammography had 77% sensitivity, 59% specificity, 63% positive predictive value (PPV), 74% negative predictive value (NPV) and 67.2% diagnostic accuracy. If we consider MRI BI-RADS categories 1, 2 and 3 as benign and 4 and 5 as malignant, MRI had 73% sensitivity, 76% specificity, 73% PPV, 76% NPV and 74.5% diagnostic accuracy. As regards disease extension, mammography had 45% sensitivity and MRI had 84.6% sensitivity. CONCLUSION: Mammography and stereotactic biopsy still remain the only techniques for characterising microcalcifications. MRI cannot be considered a diagnostic tool for evaluating microcalcifications. It is, however, useful for identifying DCIS with more aggressive histological grades. An important application of MRI in patients with DCIS associated with suspicious microcalcifications could be to evaluate disease extension after a microhistological diagnosis of malignancy, as it allows a more accurate presurgical planning.     

溢液性乳腺疾病导管造影X线征象与病理结果分析

目的:分析溢液性乳腺疾病的乳腺导管造影表现及病理基础,以提高其X线诊断水平。方法:回顾性分析216例溢液性乳腺疾病患者的导管造影及病理资料。结果:共有226支导管造影成功。无明显异常呈阴性表现者占7.5%(17/226);肿瘤性疾病占26.5%(60/226),包括导管内乳头状瘤、导管癌,其中以导管内乳头状瘤多见(22.0%);非肿瘤性疾病占59.7%(135/226),包括导管扩张、炎症及乳腺囊性增生,其中以炎症最多见(39.4%,89/226)。结论:乳腺导管造影对溢液性乳腺疾病的诊断与鉴别诊断有重要价值。     

乳腺立体定位核芯针活检的病理组织学低估原因分析

目的 分析乳腺立体定位核芯针活检的病理组织学低估的原因,以期引起临床多学科的重视及客观对待.方法 2000年9月至2005年9月,对146例乳腺病变患者(179个病变)进行立体定位核芯针病变部位穿刺活检,发生病理组织学低估21个.病变均不可触及(NPBL),根据乳腺影像报告和数据系统(BI.RADS),活检前诊断BI-RADS m类6个,Ⅳ类12个,V类3个,影像表现为钙化16个,肿块2个,不对称性致密1个,星芒征2个.结果 活检为纤维囊性乳腺病并导管上皮不典型增生11个,手术诊断为导管原位癌7个,伴早期浸润4个;活检为重度乳腺导管不典型增生3个,手术诊断为原位癌1个,原位癌伴早期浸润2个;活检为乳腺导管原位癌3个,手术证实均为浸润性癌;活检为乳头状病变4个,手术证实为原位癌及伴早期浸润各1个、浸润性导管癌及乳腺导管内乳头状腺癌各1个.结论 乳腺核芯针活检的病理组织学低估与立体定位技术、病变本身及医师的认识有关,放射科医师应熟练掌握活检技术并力求全面取材,当穿刺活检结果与影像表现不符时,应重新评价病变的实际病理诊断.     

Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings

Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56–61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget’s disease, ductal carcinoma in-situ and invasive carcinoma. MRI’s high negative predictive value of 87–98.2% is helpful in excluding malignant etiologies of PND.     

乳腺导管造影术在乳腺导管疾病中的应用

目的探讨乳腺导管造影在乳腺导管疾病诊断中的应用。方法回顾分析了56例乳腺导管造影疾病的造影检查资料,病例均经临床检查、钼靶摄片、乳导管造影检查及病理证实。结果肿瘤性病变25例,占44.64%,包括导管内乳头状瘤12例,导管内乳头状癌4例,浸润性导管癌9例;其中导管内乳头状瘤最为多见。非肿瘤性病变31例,占55.36%,其中单纯导管扩张症11例,导管扩张伴慢性乳腺炎18例,单纯导管炎症2例;其中以导管扩张伴慢性乳腺炎最为多见。结论乳腺导管造影术对乳腺导管系统疾病的诊断与鉴别诊断以及导管内乳头状癌的早期诊断具有重要的价值。     

Advanced breast biopsy instrumentation device: percentages of lesion and surrounding tissue removed

OBJECTIVE: This study reports the percentage of tissue in breast biopsy specimens from the lesion, and from the surrounding tissue, in 101 cases of Advanced Breast Biopsy Instrumentation (ABBI) biopsies. It also reports the status of the histologic margins for the malignant biopsies. MATERIALS AND METHODS: One hundred one consecutive ABBI biopsies were reviewed. The ABBI specimen radiographs were used to measure the area occupied by the entire specimen, the area excluding the lesion, and the area of the lesion alone. These areas, the length, and the width of all specimens were statistically analyzed using computer software. RESULTS: Of the 101 biopsies, histologic diagnosis was malignant in 27 and benign in 74. Of the 27 malignancies, four had negative margins and 23 had positive margins. Of the 23 with positive margins, eight were ductal carcinoma in situ (tumor within 0.5 mm or less of the surgical margin), and 15 were not ductal carcinoma in situ (tumor at the surgical margin). The average specimen length was 5.51 cm and the average width was 1.65 cm. The average percentage of lesion tissue was 9.9%. CONCLUSION: An average of 90.1% of tissue removed by ABBI biopsies was from surrounding tissue only. Uninvolved tissue is unfortunately included because of the cylindric geometry of the ABBI cannula. The ABBI biopsy has a high percentage (85.2%) of positive margins for malignant lesions and is poor excisional tool. For diagnostic biopsies, core needle biopsy is preferable because a smaller tissue volume is resected directly from the lesion site.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.

Abstract：

Objective To evaluate the role of breast MRI in detecting the primary malignancy in patients presenting solely with axillary lymph node metastases. Methods Thirty-three patients with axillary lynph node metastases but negative findings on either physical examination or mammography underwent breast MRI to identify occult breast carcinoma. MRI of the breast was assessed according to BI-RADS criteria. The pathologic diagnosis was made according to the standard criteria by the WHO Classification of Tumor. Results Among 33 patients presenting solely with axillary metastases, 30 patients underwent modified radical mastectomy. Primary breast carcinoma was proven in 17 patients. MRI detected lesions in 16 patients, including 10 masses and 6 non-mass lesions. Size of the masses ranged from 0. 5 to 2. 6 cm (mean 1.5 cm). Six lesions were smaller than 1.5 cm in size. Non-mass lesions showed ductal enhancement in 4 cases and segmental enhancement in 2 cases. One patient with tumor detected by histopathology showed no abnormal enhancement on MRI. No tumor was found at mastectomy in the other 13 womeu, and negative MR findings were revealed in 9. Four cases with suspicious enhancement on MRI had no corresponding primary foci on pathology. Three patients didn't undergo surgical procedure. The sensitivity, specificity, and accuracy of MRI in the diagnosis of the primary malignancy were 94. 1%,69. 2%, and 83.3%, respectively. Conclusions Small size of mass and ductal or segmental enhancement of non-mass lesion were common MR features of occult malignancy. MRI showed high sensitivity and accuracy in diagnosing occult breast carcinoma. Breast MRI should be taken in search of occult malignancy in patients with axillary metastases.     

乳腺导管造影在乳头溢液病因诊断中的价值

目的　探讨乳腺导管造影在乳头溢液病因诊断中的价值。方法　回顾性分析 40例乳头溢液乳腺导管造影X线表现 ,并经临床治疗或手术病理证实。结果　正常导管 7例 ,单纯导管扩张 17例 ,导管扩张伴炎症 4例 ,导管扩张伴增生 2例 ,导管内乳头状瘤 8例 ,乳腺导管癌 1例 ,乳腺脓肿 1例。结论　乳腺导管造影术对乳头溢液为主要症状的病因具有较高的诊断价值 ,为临床提供准确的诊断和治疗依据     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

Estrogen receptor and breast MR imaging features: a correlation study

PURPOSE: To compare the MRI features between estrogen receptor (ER) positive and negative breast cancers. MATERIALS AND METHODS: Breast MRI of 90 consecutive patients confirmed with invasive ductal carcinoma (IDC), 51 ER positive and 39 ER negative, were analyzed. The tumor morphology and dynamic contrast-enhanced (DCE) kinetics were evaluated based on the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon and compared. Enlarged axillary lymph nodes on MRI and choline (Cho) detection using MR spectroscopy (MRS) were also analyzed and compared. For patients receiving axillary node dissection the pathological nodal status was also compared. RESULTS: ER negative breast cancer had bigger tumors compared to ER positive cancer (3.6 +/- 2.0 cm vs. 1.8 +/- 1.3 cm, P < 0.00005). ER negative cancer was more likely to exhibit nonmass type enhancements compared to ER positive cancer (P < 0.005). Enlarged axillary lymph nodes were more frequently identified on MRI in ER negative compared to ER positive patients (P < 0.05). After excluding patients undergoing neoadjuvant chemotherapy, auxiliary lymph node status did not show significant difference between ER positive and ER negative cancer on MRI and pathology. ER negative cancer was more likely to show the malignant type enhancement kinetics (P = 0.15), rim enhancement (P = 0.15), and Cho detection on MRS (P = 0.23) compared to ER positive cancer, but it did not reach a level of statistical significance. CONCLUSION: ER negative breast cancer was more aggressive, with larger tumor size, more non-mass-type enhancement lesions, and a higher percentage showing enlarged axillary nodes on MRI. These features might be related to its poorer cellular differentiation and/or a higher angiogenesis.     

Ductography: how to and what if?

Ductography of the breast is an underused procedure that often helps define the cause of unilateral, single-pore, spontaneous nipple discharge. Since nipple discharge may be caused by benign tumors, such as papillomas, or by carcinoma, such as ductal carcinoma in situ, identification of intraductal abnormalities with ductography is important. Further, diagnostic ductography and preoperative ductography help guide accurate surgical intervention. Without prior ductography, central duct excision may not result in removal of the abnormal ductal tissue or may result in removal of only a portion of the abnormal ductal system, causing the extent of disease to be effectively understaged. Once fundamental ductographic principles are learned, the procedure is easy to perform. If extravasation occurs, ductography is rescheduled for 7-14 days later. Elimination of air bubbles from the cannula, syringe, and extension tubing is vital. When reflux occurs, radiologists must be aware of a possible tumor in the distal-most duct. When ductal ectasia or fibrocystic changes are the cause of the discharge, conservative follow-up may be considered. Diagnostic radiologists who learn the technique of ductography and include it in their evaluation of nipple discharge will improve their interdisciplinary approach to this important sign of breast cancer.