Ductal breast disease is a serious and little recognized problem in breast imaging that causes delays in management and therapy. Benign ductal lesions include duct ectasia, inflammatory changes, fibrocystic changes, intraductal papilloma and papillomatosis. Malignant ductal lesions include ductal carcinoma in situ, invasive ductal carcinoma. The patients with ductal lesions can present with variety of symptoms, the most common reported symptom is pathological nipple discharge. Clinically, the patient with ductal disease can present in a variety of scenarios, including for specific diagnostic evaluation of symptoms such as classic serous or sanguineous nipple discharge, mastitis, or generalized infectious symptoms; for evaluation of lactation-associated issues; or in the setting of routine or high-risk screening. Ultrasonography (US) and occasionally magnetic resonance (MR) imaging have largely replaced galactography or ductography at our institution secondary to increased attention to patient comfort and the dramatic increase in image resolution in US and MR imaging.There are multiple methods to evaluate the ductal system in female patients. Galactography or ductography remains the standard of reference for evaluation of the ductal system. However, because of its increased resolution, availability, and ease of use, high-resolution US is replacing galactography in evaluation of ductal disease near the nipple, such as in patients with nipple discharge

Ductal Breast Diseases, Imaging Modalities