How we perform ductulography in a tertiary referral centre for ductulography in Indonesia: case-series approach and a review

Supit, Nina I. S. H. and Kusumaningtyas, Nungky and Gultom, Fajar Lamhot and Mudzakir, Muhammad Adam and Sulay, Callistus Bruce Henfry and Octavius, Gilbert Sterling (2024) How we perform ductulography in a tertiary referral centre for ductulography in Indonesia: case-series approach and a review. Egyptian Journal of Radiology and Nuclear Medicine, 55 (231). pp. 1-14.

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Abstract

Background Ductulography is a key imaging technique for assessing nipple discharge. Despite modern advancements such as mammography and MRI, the relevance of ductulography in diagnosing pathologic nipple discharge (PND) remains signifcant, particularly in low-resource settings. This review examines our single-center experience with ductulography in Indonesia, highlighting patient characteristics and procedural outcomes. Methods This review is based on case-based experiences from a private tertiary hospital in Indonesia, a main referral center for ductulography. We describe 28 women who underwent ductulography between January 2019 and June 2024. This review is supplemented by the theories of ductulography and how we do it in our institution. Results The median age of the patients was 46.5 years (IQR: 42–53.5 years). Among the 28 women, 2 experienced non-spontaneous discharge, 12 had colorless discharge, 12 had bloody discharge, and the remaining had yellowish to brownish discharge. Laterality was almost evenly distributed with 14 right-sided, 13 left-sided, and 1 bilateral discharge. The Galactogram Imaging Classifcation System (GICS) outcomes were 2 patients with GICS 0, 7 with GICS 1, 17 with GICS 2, and 2 with GICS 4a. Histopathologic analyses were performed on three patients, revealing fbrocystic changes in two and intraductal papilloma with fbrocystic changes in one. Conclusions While ductulography may be considered an older technique, it remains a valuable diagnostic tool in the modern imaging era, especially in settings with limited access to advanced imaging modalities. Our singlecenter experience supports the continued use of ductulography, providing crucial preoperative mapping and aiding in the accurate diagnosis of PND. Keywords Ductulography, Indonesia, Pathologic nipple discharge, Mammography, Magnetic resonance imaging

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