Synonym/Acronym
Fiberoptic ductoscopy, ductogram, galactography, mammary ductoscopy.
Rationale
To visualize and assess the breast ducts for disease and malignancy in women with nipple discharge.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction. Inform the patient not to apply deodorant, body creams, or powders on the day of the procedure, as they may interfere with the mammography.
Normal Findings
Study type: Endoscopy with x-ray imaging; related body system: Immune and Reproductive systems.
The female breast is composed mostly of fatty tissue and a specialized type of glandular tissue, which is organized into 12 to 20 lobes. Each lobe contains clusters of smaller lobules that produce milk. The milk is transported to the breast nipple through a network of ductules connected to the lobes and lobules.
Ductography is an imaging procedure used to visualize the ductal system of the breast and to investigate reasons for production of nipple discharge in the anatomical area of interest. The majority of both benign and malignant breast disease originates from the cells that line the ductal-lobular unit. In ductography, the lactiferous duct is identified, cannulated, and injected with a small amount of radiopaque contrast medium such as Conray (a solution containing iothalamate meglumine) followed by mammographic imaging.
Ductography is not indicated in patients with bilateral discharge because this is generally caused by hormonal changes. Biopsy and ablation techniques can also be performed during ductoscopy with correlation between visual findings and histopathology.
Contraindications
Pregnancy is a general contraindication to procedures involving radiation.
Patients younger than age 25, because the density of the breast tissue is such that diagnostic x-rays are of limited value.
Patients with conditions associated with adverse reactions to contrast medium (e.g., asthma, food allergies, or allergy to contrast medium). Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids and diphenhydramine; the use of nonionic contrast or an alternative noncontrast imaging study, if available, may be considered for patients who have severe asthma or who have experienced moderate to severe reactions to ionic contrast medium.
Patients with bleeding disorders receiving an arterial or venous puncture, because the site may not stop bleeding.
Factors That May Alter the Results of the Study
- Metallic objects within the examination field (e.g., jewelry, body rings), which may inhibit organ visualization and can produce unclear images.
- Application of substances such as talcum powder, deodorant, or creams to the skin of breasts or underarms, which may alter test results.
- Previous breast surgery, breast augmentation, or the presence of breast implants, which may decrease the readability of the examination.
Abnormal Findings Related to
- Ductal thickening
- Papillary lesions (cancerous or noncancerous)
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this procedure can assist in evaluating the breast and mammary ducts for disease.
- Inform the patient that the procedure is usually performed in a mammography department and takes about 30 to 60 min.
- Review the procedure with the patient.
- Explain that pregnancy testing may be required.
- Explain that there may be moments of discomfort experienced during the test.
- Explain that a topical anesthetic may be applied to the nipple before the procedure to decrease discomfort. Refer to study specific protocol.
Procedural Information
- Positioning for the study is in the supine position on an examination table.
- Prior to the examination, the nipple is cleansed with an appropriate disinfectant material.
- Gentle manual periareolar pressure is placed on the area of interest to identify the duct with the discharge by squeezing a small amount of fluid from the duct. A warm towel may be used to help visualize the location of the duct prior to cannulation.
- Once the duct is identified it will be cannulated until it passes beyond the sphincter of the orifice.
- A small amount of radiopaque contrast is injected into the duct, allowing gravity to move it.
- Afterwards the cannula is taped to the breast, and the patient will be assisted to the mammography unit for mammographic images.
- When the study is completed, the cannula is removed and a dressing applied over the nipple.
Safety Considerations
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Infection or bleeding. Observe/assess the cannula insertion site for bleeding, inflammation, or hematoma formation.
Treatment Considerations
- Instruct the patient in the care and assessment of the injection site.
- Discuss the pathophysiology associated with breast cancer as well as ongoing treatment, screenings, and medical versus surgical options. For additional information regarding diagnosis of breast cancer, refer to the studies titled “Biopsy, Breast” and “Cancer Markers.”
- Instruct in the use of any ordered medications and the importance of adhering to the therapy regimen and review significant adverse effects associated with the prescribed medication. Encourage the patient to review corresponding literature provided by a pharmacist.
- Discuss how breast screening guidelines between organizations may not always agree; therefore, it is important for patients to participate in their health care, be informed, ask questions, and follow their HCP’s recommendations regarding frequency and type of screening. For additional information regarding screening guidelines, refer to the study titled “Mammography.”
Clinical Judgement
- Consider how to overcome the emotional impact of body image changes to focus on treatment modalities.
Follow-Up and Desired Outcomes
- Understands that decisions regarding the need for and frequency of breast self-examination, mammography, magnetic resonance imaging or ultrasound of the breast, or other cancer screening procedures should be made after consultation between the patient and HCP.
- Acknowledges that the most current guidelines for breast cancer screening of the general population as well as of individuals with increased risk are available from the American Cancer Society (ACS) (www.cancer.org), the American College of Obstetricians and Gynecologists (www.acog.org), and the American College of Radiology (www.acr.org).
- Understands that screening guidelines vary depending on the age and health history of those at average risk and those at high risk for breast cancer.