Diagnosis and Management of Common Ductal Abnormalities

Ductal anatomy is reviewed, imaging and biopsy methods are discussed, and benign and malignant conditions associated with the ductal system are presented.

Course ID: Q00357 Category:
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3.25

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Outline

  1. Introduction
  2. Ductal Anatomy
  3. Imaging Evaluation
    1. Galactography
    2. Untrasonography
    3. MR Imaging
  4. Biopsy Methods and Technical Issues Specific to Sampling of Ductal Abnormalities
  5. Benign Diseases
    1. Duct Ectasia
    2. Blocked Ducts
    3. Inflammatory Infiltrates
    4. Periductal Mastitis
    5. Apocrine Metaplasia
    6. Papillomas
    7. Papillomatosis
  6. Malignant Diseases
    1. Ductal Carcinoma in Situ
    2. Invasive Ductal Carcinoma
    3. Paget Disease
  7. Conclusions

Objectives

Upon completion of this course, students will:

  1. identify the advantage of vacuum-assisted biopsy
  2. identify benign lesions of the ducts
  3. know the importance of the basement membrane
  4. describe nonspontaneous discharge
  5. be familiar with physiologic nipple discharge
  6. evaluate the need for follow-up to spontaneous nipple discharge
  7. identify the TDLU anatomy
  8. discuss the function of myoepithelial cells
  9. discuss the anatomy of Cooper’s ligaments
  10. understand the use of galactography
  11. discuss the termination of the galactogram procedure
  12. discuss the amount of compression used in galactography
  13. be familiar with the normal appearance of the ducts on US
  14. identify the variability in the ducts due to the lactational state of the patient
  15. identify the cause of high intensity signal on MR imaging
  16. discuss the difficulty of MR guided breast biopsy of the retroareolar region
  17. discuss the use of site markers after vacuum assisted biopsy
  18. define ductal ectasia
  19. understand the relevance of peripherally located ectasia
  20. discuss the evolution of blocked ducts into mastitis
  21. know the organisms involved in lactation associated infections
  22. know the methods of symptom relief for blocked ducts
  23. identify the characteristics of lesions caused by inflammatory infiltrates
  24. be familiar with risks factors for periductal mastitis
  25. know the characteristics of apocrine metaplasia
  26. discuss how apocrine metaplasia is demonstrated on glactography
  27. explain how cysts are formed in apocrine metaplasia
  28. identify the characteristics of benign solitary papillomas
  29. explain the characteristics of papillomas on color Doppler ultrasound
  30. discuss the characteristic of papillomas on MR imaging
  31. compare the risk of breast cancer of patients with papillomatosis to average women
  32. identify the origin of DCIS
  33. discuss the appearance of microcalcifications in DCIS
  34. know the appearance of invasive ductal cancer on mammography
  35. identify the biopsy technique needed if an invasive cancer is cystic in nature
  36. list the three main categories of primary invasive breast cancer
  37. identify the specific malignant characteristics of invasive ductal carcinoma on US
  38. know the surgical procedures that most patient with Paget disease undergo
  39. discuss how Paget disease is diagnosed
  40. identify the symptoms of Paget disease