Radiol Oncol 1998; 32(1): 257-108
Invasive oncoradiology in the diagnosis of breast tumor.
Case report
Gabor Szalai1, Laszlo Kaiser2, Endre Kalman2
1Department of Radiology, 2Department of Pathology, University School of Medicine, Pecs,
Hungary
In the haemorrhage discharging breast of an elder woman no tumor mass could be detected by mammography. An obstruction in a duct without tumor mass was detected by ductography. Fine needle aspiration biopsy was performed in the area close to and behind the obstruction. The cytopathological diagnosis was "Papilloma seu carcinoma papillare". Surprisingly, the same duct filled completely during ductography after biopsy. After ultrasound-guided wire localization, the success of surgical treatment was confirmed by histology
Key words: breast neoplasms-diagnosis-pathology; mammography, ductography; biopsy, needle, fine-needle aspiration biopsy (FNAB), wire localization
Introduction
Haemorrhage discharge of the mamilla is frequently caused by papilloma or papillary carcinoma.1,2 Ductography is generally accepted procedure to assess the localization and extension of tumor.3
Case Report
A 62-year old woman was referred to the hospital because of the haemorrhage discharge of the left breast. There was no palpable abnormality. A papillary growth was detected cytopathologically and the cells in the dis-
Correspondence to: Ga'bor Szalai, MD, University School of Medicine, H-7624 Pecs, Ifjuság 13, Fax: +36 72 311 214.
charge indicated to the presence of a cystic lesion. No tumor could be identified by mammography (Figures la,b). The contrast media filled up a short, wide part of a duct during ductography (Figures 2a,b). The diameter of this retroareolar part of the duct, measured by sonography, was 2.8 mm and there was not any solid lesion visible (Figure 3). From the area immediately behind the obstruction, US-guided aspiration biopsy was performed (Figure 4). Papillary neoplasm was detected by cytology. One month later (in the meanwhile, discharging stopped), ductography was repeated. The ducts of the upper-outer quadrant were filled-up with contrast media. A part of the tumor closing the central duet was removed by biopsy, and the total obstruction was thus eliminated. Multiple filling defects were seen intraductally (Fig-
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Figure 1 a,b. No tumor could be »identified by mammography.
ures 5a,b). Immediately after this procedure, a US-guided wire localization was performed (Figures 5a,b and Figure 6) and an excision was made within an hour. The surgical sample was examined by mammography (Figures 7a,b). In this preparatum, the tumor could not be seen macroscopically, but the area immediately at the end of the wire was histologically examined: it proved to be a papilloma.
Fi^re 2 a,b. The contrast media filled up a short, wide part of a ducat during ductography.
Discussion
Beside mammography,4 sonography is a basic procedure in diagnosing breast diseases.5,6 Ductography has long been a procedure used for examination nipple with haemorrhage discharge (suspicious of intraductal mass),1-3 and it has usually been followed by surgery. When a tumor obstructs completely the intra-

Figure 4. From the area immediately behind the obstruction, Us-guided aspiration biopsy was performed (arrow shows to the needle).
Figure 6. The left arrow shows to the canula, the tight to the wire; multiple filling defects were seen intraductally.
Figure 5 a,b. A wire locatization was performed after second filling of the duct
ductal passage, the contrast media cannot fill the duct behind the obstruction,7 so the exact extension is not known before operation. Imaging procedures performed and recommended by many authors are the following: mammography, sonography and ductography.8 The radiologist should perform biopsy to obtain a sample for cytological examination and to estimate the total block. Repeated
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ductography allows a more precise estimation of the extension of any intraductal growth. After wire localization, proper surgery can be performed.
References
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