Self-cannulation for ductography of the breast.

Abstract

annulation of the duct orifice for ductography is a source of great stress for many radiologists, especially for those who do not perform the procedure frequently. With the standard technique, the radiologist inserts the cannula into the patient while she is supine or sitting. In cases of difficulty, maneuvers such as placing traction on the nipple or applying a warm compress are advocated [1]. Although the procedure is painless once the cannula has been inserted, placement of the cannula usually requires effort, including gentle probing with the cannula to find the proper alignment that will allow it to pass into the duct lumen, which is often tortuous at or near the orifice. It has been our experience that what seems like gentle probing to the radiologist is actually experienced as at least moderate discomfort or, in cases of difficult cannulation, pain by the patient. To reduce the discomfort to the patient, we have developed a technique in which the woman inserts the ductography cannula herself. Subjects and Methods We use a standard 30-gauge bent ductography cannula. We prepare the cannula in the usual way by attaching a 1-mL tuberculin syringe to the tubing and loading the tubing with contrast material, taking care to eliminate all bubbles. The patient is instructed to wash her hands before the procedure. We then assist her in cleansing her nipple and areola with an alcohol swab. She is instructed to grasp the portion of the cannula proximal to the bend without touching the distal portion. She then elicits a small amount of discharge from her nipple and places the cannula into the orifice from which the discharge is emanating. The radiologist or technologist then secures the cannula with tape in the usual fashion. We inject contrast material until the patient senses fullness or discomfort in her breast. Results We have offered self-cannulation to 14 patients. Four refused and were successfully cannulated by the radiologist. Of the 10 who attempted self-cannulation, all but one were successful. The one patient who was unsuccessful could not be cannulated by the radiologist either. At her duct excision, only fibrocystic changes were found. Of the nine patients who successfully selfcannulated, five had abnormal ductograms showing dilated ducts and one filling defect and one had dilatated ducts and two filling defects. All these patients had one papilloma proven at excision. One other ductogram showed only dilatated ducts without filling defects. This patient’s surgery was cancelled when her nipple discharge decreased and other medical problems became more pressing. The ductograms in these seven patients were all subjectively of good quality with no overfilling or extravasation. Two patients had normal ducts at ductography. On one of these studies, there was overfilling of the duct causing extravasation of contrast material more than 1 cm from the nipple. This patient did not indicate any fullness or pain during the injection, which was stopped at 0.7 mL. Her duct excision revealed only fibrocystic changes. The other patient’s study was of good quality; however, her surgery was cancelled when her discharge stopped in the weeks following the ductogram. Although not quantified, the patients who self-cannulated had much shorter cannulation times and appeared to have significantly less discomfort from the procedure than those who were cannulated by the radiologist. No immediate or delayed complications were reported after either self-cannulation or cannulation by the radiologist. Discussion