Ductography is an X-ray contrast study that displays the lobular milky ducts and their branching. The results allow us to judge the patency of the ducts, the presence of deformities, displacements, cystic cavities, tumor formations (papillomas, intracurrent cancer). The contrast solution is injected with a needle into the secerning ducts. Radiography is performed in the upper-lower and oblique projection.
The method of ductography has narrowly focused indications. Its main purpose is to detect intra-flow papillomas, cancer, adenomas and breast cysts. By means of ductography, intra-current formations with a size of 1 mm can be detected. The direct basis for the study is pathological secretion – discharge from the nipple of a hemorrhagic (bloody, brown) or serous nature. Since cases of pathological secretion from the breast can be caused by various reasons (deformation of the ducts during mastopathy, inflammation, endocrine pathology, intracurrent formations), ductography is supplemented by a study of a smear from the breast nipple, determination of prolactin and breast cancer cancer marker CA 15-3.
Suspicion of intra-current formations usually occurs with the unilateral nature of bloody or serous-amber secretions. With the help of ductography, the causes of pathological secretion are established in 92-96% of cases. In addition, the exact location and prevalence of intra-current changes are determined, which is extremely important for planning surgical treatment. In some cases, the procedure has a therapeutic effect: after washing the duct with a contrast agent, pathological discharge from the nipple stops in some patients.
Diagnosis is contraindicated in case of allergy to iodine-containing contrast, pregnancy, acute inflammation of the breast (mastitis, abscess), lactation, atypical cells in smears-prints of breast secretions and palpable tumors in the area of the excretory ducts in order to prevent the migration of malignant cells through the ducts. Ductography is performed on the 5th-12th day from the beginning of the last menstruation; there are no restrictions on the duration of the procedure for menopausal women.
Methodology of conducting
Ductography is performed in an X-ray room equipped with a mammography unit. Before the procedure, a woman needs to undress to the waist, removing her body jewelry. It is strictly forbidden to try to massage or squeeze the mammary gland yourself in order to avoid traumatization of the ducts. 2-3 days before ductography, it is recommended to start taking antispasmodic drugs.
After treating the areola, the doctor presses on the nipple, looking for the discharge opening of the milky duct by the secreted secret. Then a thin dilator is inserted into the duct opening to expand it. With the help of a flexible plastic cannula, contrast (verografin, urotrast, etc.) is injected into the duct in an amount of 0.25-0.5 ml. After that, the mammary gland is placed on the mammograph stand, pressed with a plate and X-rays are taken in a straight and oblique projection. Breast compression ensures an even distribution of contrast along the ducts, minimizes its amount, and the use of a flexible cannula prevents air emboli from entering the ducts, which may complicate the subsequent evaluation of ductograms. After the end of the ductography, the contrast is removed. The study lasts about 30 minutes, may be accompanied by slight discomfort.
Interpretation of results
On the obtained ductograms, the milky ducts with branching are clearly distinguishable, which makes it possible to identify filling defects, deformation of the ducts, their caliber, expansion or narrowing, outlines, shape and localization of tumor-like changes. An experienced radiologist or mammologist will distinguish dystrophic or other changes from intracurrent cancer based on ductography. When detecting intra-flow papillomas, it is shown that a sectoral resection of the breast is performed, since such changes are regarded as a precancerous disease. In case of confirmation of intracurrent breast cancer, a follow-up examination is performed, including lung radiography, chest CT, abdominal ultrasound, scintigraphy, and mastectomy is performed.
During ductography, there is a slight risk of injury to the milky duct when a catheter or contrast is inserted. Usually such injuries go away on their own without additional interventions. If the catheter enters the unchanged duct, the results will be false negative, not revealing the desired changes. Radiation exposure during ductography does not pose a danger and does not have a carcinogenic effect.