Galactograhy as a Minimally Invasive Diagnostic"Modality For Intraductal Carcinoma With Nipple Discharge
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This study was designed to evaluate the diagnostic yield of various galactographic patterns detected in patients with nipple discharge in comparison to results of histopathological examination of excised specimens and comprised 17 female patients presented with spontaneous unilateral persistent, resisting medical treatment nipple discharge, All patients underwent galactographic examination; abnormal galactographic patterns include: leafless-tree, intraductal filling defect or cut-off, architectural distortion/ductal compression, or ductal destruction pattern. After galactographic examination, all patients underwent localized excision of the affected main duct and the harvested specimen was examined histopathologically. Three galactographic examinations showed filling errors and were excluded of the study. Three galactograms (17.6%) showed normal pattern, 4 (23.5%) showed dilated duct, 2 (11.8%) showed leafless tree pattern, while another 2 examinations (11.2%) revealed a filling defect and the other 3 galactograms showed cutoff pattern, architectural distortion, and ductal destruction, respectively. Histopathological examination of the 14 excised specimens reported 2 duct ectasia, 5 lihrocystie disease, 4 duct papilloma and 3 duct carcinoma. Galactography could define cases with duct carcinoma with sensitivity rate of 100%, specificity rate of 91% and accuracy rate of 93%, but could exclude duct carcinoma with NPV of 100% as no case was missed with galactography, while 2 cases were diagnosed as having duct papilloma depending on the presence of dilated duct and pathological examination revealed the presence of fibrocystic disease of the breast without other pathology. Thus, the presence of only dilated duct could diagnose duct papilloma with specificity rate of 83.3% and accuracy rate of 85.7%. It could be concluded that galactography could aid surgical decision making as regards cases of intraductal carcinoma depending on the presence of a combination of characteristic galactographic patterns of malignancy and could be used as a preliminary minimally invasive diagnostic modality to reduce the number of unneededbreast biopsies.