Category Archives: Breast Imaging

When is a galactogram done?

Galactogram = Ductogram

Usually done for spontaneous unilateral bloody nipple discharge.  Sometimes it is done for serous (clear) discharge.

90% of the women with unilateral bloody nipple discharge = benign intraductal papilloma, a solitary discrete intraductal mass.  However if multiple masses are discovered in the duct, the more likely the diagnosis will be ductal carcinoma in situ (DCIS).

Regardless of single mass or multiple mass, a surgical biopsy (excisional biopsy) is required for diagnosis.  Methylene blue dye can assist the surgeon in removing the duct in the OR.

What is BI-RADS in Breast Imaging?


  • BIRADS stands for breast imaging reporting and data systems.  It was created to standardize mammographic results.
  • Biopsy is not required for BI-RADS 1,2, and 3.
  • BI-RADS 0 indicates technical concerns.
  • Proceeding to biopsy without additional imaging is strongly indicated for BI-RADS 4 or 5.
  • Family history is not a part of the breast imaging reporting and data (BIRADS).


  • If a BI-RADS 4 lesion ends up being benign, it is most likely a fibrocystic process (rather than a fibroadenoma – which occurs more likely in BI-RADS 3 patients.
  • The frequency of carcinoma is 25-30% in BI-RADS 4 lesions associated with a mass.
  • Ductal carcinoma (DCIS) is the most common malignancy with BI-RADS 4 patients, then next common is invasive ductal carcinoma.  This order is reversed in BI-RADS 5 patients.
  • No additional imaging needed.