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. |
