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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.


  • 1 Love SM, Barsky SH. Anatomy of the nipple and breast ducts revisited. Cancer 2004;101(9):1947–1957. Crossref, MedlineGoogle Scholar
  • 2 Moffat DF, Going JJ. Three dimensional anatomy of complete duct systems in human breast: pathological and developmental implications. J Clin Pathol 1996;49(1):48–52. Crossref, MedlineGoogle Scholar
  • 3 Kopans D. Breast imaging. 2nd ed. Philadelphia, Pa: Lippincott-Raven, 1998. Google Scholar
  • 4 Nicholson BT, Harvey JA, Cohen MA. Nipple-areolar complex: normal anatomy and benign and malignant processes. RadioGraphics 2009;29(2):509–523. LinkGoogle Scholar
  • 5 Cardenosa G, Doudna C, Eklund GW. Ductography of the breast: technique and findings. AJR Am J Roentgenol 1994;162(5):1081–1087. Crossref, MedlineGoogle Scholar
  • 6 Hou MF, Huang CJ, Huang YS, et al.. Evaluation of galactography for nipple discharge. Clin Imaging 1998;22(2):89–94. Crossref, MedlineGoogle Scholar
  • 7 Rumack CM, Wilson SR, Charboneau JW. Diagnostic ultrasound. St Louis, Mo: Mosby–Year Book, 1991. Google Scholar
  • 8 Da Costa D, Taddese A, Cure ML, Gerson D, Poppiti R, Esserman LE. Common and unusual diseases of the nipple-areolar complex. RadioGraphics 2007;27(Spec Issue):S65–S77. LinkGoogle Scholar
  • 9 Kim KW, Cho KR, Seo BK, et al.. Sonographic findings of mammary duct ectasia: can malignancy be differentiated from benign disease? J Breast Cancer 2010;13(1):19–26. CrossrefGoogle Scholar
  • 10 Dixon JM, Ravisekar O, Chetty U, Anderson TJ. Periductal mastitis and duct ectasia: different conditions with different aetiologies. Br J Surg 1996;83(6):820–822. Crossref, MedlineGoogle Scholar
  • 11 Cotran RS, Kumar V, Robbins SL. Robbins pathologic basis of disease. 5th ed. Philadelphia, Pa: Saunders, 1994; 1093–1094. Google Scholar
  • 12 Kushwaha AC, O’Toole M, Sneige N, Stelling CB, Dryden MJ. Mammographic-pathologic correlation of apocrine metaplasia diagnosed using vacuum-assisted stereotactic core-needle biopsy: our 4-year experience. AJR Am J Roentgenol 2003;180(3):795–798. Crossref, MedlineGoogle Scholar
  • 13 Kalisher L, Rickert RR, Sharo RJ. Solitary peripheral papilloma of the breast: a radiologic-pathologic correlation of a benign lesion that may mimic breast cancer on mammography. AJR Am J Roentgenol 1998;171(3):605–609. Crossref, MedlineGoogle Scholar
  • 14 Chang JM, Moon WK, Cho N, et al.. Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy. AJR Am J Roentgenol 2011;196(3):723–729. Crossref, MedlineGoogle Scholar
  • 15 Youk JH, Kim EK, Kwak JY, Son EJ, Park BW, Kim SI. Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy. Radiology 2011;258(1):81–88. LinkGoogle Scholar
  • 16 Brookes MJ, Bourke AG. Radiological appearances of papillary breast lesions. Clin Radiol 2008;63(11):1265–1273. Crossref, MedlineGoogle Scholar
  • 17 Tominaga J, Hama H, Kimura N, Takahashi S. Magnetic resonance imaging of intraductal papillomas of the breast. J Comput Assist Tomogr 2011;35(1):153–157. Crossref, MedlineGoogle Scholar
  • 18 Muttarak M, Lerttumnongtum P, Chaiwun B, Peh WC. Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol 2008;191(3):700–707. Crossref, MedlineGoogle Scholar
  • 19 Slanetz PJ, Giardino AA, Oyama T, et al.. Mammographic appearance of ductal carcinoma in situ does not reliably predict histologic subtype. Breast J 2001;7(6):417–421. Crossref, MedlineGoogle Scholar
  • 20 Rosen EL, Smith-Foley SA, DeMartini WB, Eby PR, Peacock S, Lehman CD. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J 2007;13(6):545–550. Crossref, MedlineGoogle Scholar
  • 21 Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol 2003;181(2):519–525. Crossref, MedlineGoogle Scholar
  • 22 Kaelin CM. Paget’s disease. In: Harris JRLippman MEMorrow MOsborne CK, eds. Diseases of the breast. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2004. Google Scholar

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