Breast sonography in localizing the cause of nipple discharge: comparison with galactography in 52 patients.

Objective: The purpose of this study was to evaluate breast sonography in localizing abnormalities in the discharging duct in patients with spontaneous nipple discharge.

Methods: Fifty-two patients with unilateral bloody or serous nipple discharge and normal findings on palpation and mammography underwent breast sonography before surgical duct excision. The results of sonography were compared with the findings of galactography and histologic examination of the surgical specimen.

Results: The final diagnosis was benign in 47 cases (90%) and malignant in 5 cases (10%). Sonography visualized an echogenic intraductal tumor in 36 (69%) of 52 cases, dilated duct(s) without an intraductal tumor in 6 cases (12%), and no abnormality in 10 cases (19%). Eighty percent of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive. The abnormal duct was surgically removed after methylene blue staining in 38 cases, after sonographically guided wire localization in 11 cases, after both wire localization and methylene blue staining in 1 case, and with review of the diagnostic galactographic images in 2 cases.

Conclusions: Sonography was found to be a valuable method for localizing intraductal abnormalities, especially papillomatous lesions, in patients with nipple discharge with no other clinical or radiologic findings. Preoperative sonographically guided wire localization can be used successfully instead of conventional methylene blue staining in cases with problems in cannulation of the discharging duct. Galactography remains the primary diagnostic method, especially in depicting malignant causes of nipple discharge, which may be seen only as duct dilatation on sonography.