Published Online:https://doi.org/10.1148/rg.324115150

Appearances of benign and malignant conditions of the milk ducts of the breast with various imaging modalities are reviewed, with emphasis on features that favor a benign over a malignant diagnosis, and percutaneous biopsy methods are discussed, including the role of vacuum-assisted biopsy.

Ductal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal–lobular unit. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling.

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Article History

Received: Aug 19 2011
Revision requested: Sept 23 2011
Revision received: Jan 27 2012
Accepted: Mar 6 2012
Published online: June 27 2012
Published in print: July 2012