J Breast Cancer.  2014 Jun;17(2):184-187.

Microdochectomy Assisted by Ultrasound-Guided Indigo Carmine Staining of Intraductal Lesions: A Case Report

• Jeong BY
• Kim DB
• Kwak BS

Abstract

Spontaneous bloody nipple discharge from a single duct is a significant clinical problem. When performing preoperative marking of the discharging duct, it is sometimes difficult to identify the duct owing to intermittent discharge. Precise preoperative marking of the discharging duct and intraductal lesions is very important to avoid unnecessary wide excision of breast tissue or failure to remove the cause of nipple discharge. We herein present a case of preoperative ultrasound-guided indigo carmine staining in a patient with no discharge on the day of surgery. When a dilated duct is visualized on ultrasound, the targeted duct can be localized using indigo carmine staining, and it is possible to perform a precise minimal volume microdochectomy.

Keyword

Indigo carmine; Ultrasonography; Ultrasound-guided

MeSH Terms

Breast
Humans
Indigo Carmine*
Nipples
Ultrasonography
Indigo Carmine

Figure

• 

  Figure 1 Images of a 35-year-old female with spontaneously intermittent bloody discharge from the right nipple for 4 months. (A) A mammography shows an asymmetric tubular structure in the subareolar area (arrow) and a 3.2 cm tortuous tubular structure (arrowhead) in the upper outer quadrant of the right breast. (B) A sonogram shows a dilated duct with isoechoic intraductal lesions (arrows) in the subareolar area and 2 cm from the nipple and a tortuous tubular intra- and extra-ductal mass (arrowheads) 5 cm from the nipple. (C) A right craniocaudal galactogram shows three polypoid filling defects (arrows) and ductal cutoff (arrowhead) in the dilated lactiferous duct. This dilated duct is correlated with the asymmetric tubular tortuous structures in the subareolar area and upper outer quadrant of the right breast on mammography (not shown). (D) The reconstructed maximum intensity projection of a contrast-enhanced magnetic resonance image shows a 4.4 cm area of linear and clumped nonmass enhancement (arrows). (E) On the day of the surgery, a needle (arrow) was inserted in the dilated duct in the 10 o'clock region of the right breast under ultrasound guidance. After injection of a small volume of indigo carmine into the dilated duct, the targeted duct became more dilated, and dye was discharged from the one orifice of the right nipple (not shown). (F) Photograph of the microdochectomy procedure. After dissection, the indigo carmine-stained duct (arrows) was evident in the operative field, and was easy to perform minimal-volume microdochectomy.

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