Galactography is a radiographic procedure used in the field of gynecology (women’s health). In this examination, the milk ducts of the female mamma (breast) are visualized with the help of X-ray contrast medium to visually show pathologic (pathological) changes. Galactography is used to diagnose disease processes that occur within the milk ducts, such as small intraductal carcinomas (cancer confined to the cells of the milk duct (= DCIS)), papillomas (benign mucosal tumors), or chronic inflammatory processes.
Indications (areas of application)
Indication and prerequisite for this examination is a pathological (pathological) secretion (leakage of fluid) from the nipple (breast). This is particularly noticeable when only one mammary gland is affected. Pathological secretion must be distinguished from galactorrhea. Galactorrhea is the milky secretion outside of gravidity (pregnancy) and lactation. The cause of galactorrhea is usually an endocrinological (hormonal) disorder. Galactography is performed in:
- Hemorrhagic (bloody) secretion from the nipple (both clinical evidence and cytologic evidence).
- Unilateral, non-hemorrhagic secretion.
- Detection of tumor cells or atypia (“deviation from the norm”) in cytological findings (cell examination).
Contraindications
- Acute inflammatory processes of the mammary gland.
- Allergy to contrast media
Before the examination
The examination is usually preceded by a clinical examination, an orienting conventional mammogram (X-ray of the breast) and a cytological examination of the secretion.
The procedure
Galactography can be performed only if there is pathologic secretion with dilatation of the milk ducts, because in this situation the opening of the milk duct can be seen. During galactography, the patient should lie comfortably and the breast should be well illuminated. In case of very heavy secretion, the mammary gland is first manually smoothed out to remove thickened secretion or blood coagulum (blood clot). This is followed by thorough disinfection of both the nipple and surrounding skin. In case of pain, local anesthesia (local anesthesia) is possible. The examining physician uses magnifying glasses to locate the milk duct in question and carefully probes it with a blunt galactography needle (e.g. Cook galactography catheter). Once the needle is positioned, 0.1 to 0.5 ml of water-soluble contrast medium is carefully injected without air via a contrast medium syringe connected to the needle by a tube system. Now the excretory duct is compressed with the aid of a swab or plaster to prevent leakage of the contrast medium until the X-ray image is taken. Subsequently, the mammogram is taken in 2 planes, which can be supplemented by magnification images. The following conditions can lead to image artifacts (erroneous image findings):
- Air injection
- Spastic (cramped) constriction of the milk ducts
- Insufficient amount of contrast agent
- Blocked milk ducts, e.g., due to blood coagulum.
- Too much compression of the breast during mammography.
Finally, the radiographs are evaluated, paying particular attention to ductasia (dilatation of the milk ducts), filling defects and ductal breaks.
After the examination
No special measures are necessary after the examination. If abnormal findings are found, histologic (fine tissue) clarification (biopsy) is usually necessary because galactography does not allow differentiation between a benign and a malignant finding.
Possible complications
- Anaphylactic reaction (severe allergic reaction) in contrast medium allergy.
- Galactophoritis (inflammation of the milk ducts).
- Mastitis (inflammation of the breast)
- Extravasation – accumulation of contrast material outside the mammary ducts, e.g., in the lymphatic ducts, leading to difficult assessment of the examination.
