Failure to cannulate the discharging duct may lead to a false negative [43]. Ductography is not recommended in lactating women or patients with active mastitis. Known hypersensitivity to iodinated contrast agents is a relative contraindication. Findings on ductography suggestive of malignant or papillary lesions include intraductal filling defect, partial or complete obstruction of a duct, duct expansion or distortion, and duct wall irregularity [1]. In patients with pathologic nipple discharge and a negative mammogram and US, Morrogh et al [44] reported the PPV and NPV of ductography for detection of cancer and high-risk lesions to be 19% and 63%, respectively. In the setting of negative standard evaluations, ductography localized 76% of otherwise occult malignant/high-risk lesions and 91% of benign lesions [39]. When the standard evaluation is positive, ductography facilitated preoperative localization of the causative lesion in 78% of cases [39]. For detection of cancer in patients with pathologic nipple discharge, 2 studies showed the sensitivity, specificity, PPV, and NPV of ductography to be 75% to 100%, 6% to 49%, 16% to 18%, and 93% to 100%, respectively [16,23]. For detection of high-risk lesions, Adepoju et al [16] reported the sensitivity, specificity, PPV, and NPV of ductography to be 75%, 53%, 22%, and 92%, respectively. Ductography is more sensitive than mammography and US but has lower specificity than both modalities. A negative ductogram does not reliably exclude an underlying cancer or high-risk lesion, with the false-negative rate reported to be as high as 20% to 30% [44]. As such, the primary value of ductography is to localize intraductal lesions and assist in surgery [45]. A study found that patients who underwent ductography-guided operations or any other surgical procedure with image guidance of the lesion were significantly more likely to have a specific underlying lesion identified than patients who underwent central duct excision alone [23,42].
Evaluation of Nipple Discharge. Failure to cannulate the discharging duct may lead to a false negative [43]. Ductography is not recommended in lactating women or patients with active mastitis. Known hypersensitivity to iodinated contrast agents is a relative contraindication. Findings on ductography suggestive of malignant or papillary lesions include intraductal filling defect, partial or complete obstruction of a duct, duct expansion or distortion, and duct wall irregularity [1]. In patients with pathologic nipple discharge and a negative mammogram and US, Morrogh et al [44] reported the PPV and NPV of ductography for detection of cancer and high-risk lesions to be 19% and 63%, respectively. In the setting of negative standard evaluations, ductography localized 76% of otherwise occult malignant/high-risk lesions and 91% of benign lesions [39]. When the standard evaluation is positive, ductography facilitated preoperative localization of the causative lesion in 78% of cases [39]. For detection of cancer in patients with pathologic nipple discharge, 2 studies showed the sensitivity, specificity, PPV, and NPV of ductography to be 75% to 100%, 6% to 49%, 16% to 18%, and 93% to 100%, respectively [16,23]. For detection of high-risk lesions, Adepoju et al [16] reported the sensitivity, specificity, PPV, and NPV of ductography to be 75%, 53%, 22%, and 92%, respectively. Ductography is more sensitive than mammography and US but has lower specificity than both modalities. A negative ductogram does not reliably exclude an underlying cancer or high-risk lesion, with the false-negative rate reported to be as high as 20% to 30% [44]. As such, the primary value of ductography is to localize intraductal lesions and assist in surgery [45]. A study found that patients who underwent ductography-guided operations or any other surgical procedure with image guidance of the lesion were significantly more likely to have a specific underlying lesion identified than patients who underwent central duct excision alone [23,42].