Chapter 47 Diagnostic mammography is currently the test of choice in the workup of PND and is generally indicated in all patients. Ultrasound, magnetic resonance imaging (MRI), and ductography are being studied for prediction of malignant disease in PND, although no consensus exists on their use. Also under investigation is ductoscopy, real-time endoscopic imaging of the ductal system. Ductoscopy can differentiate normal ducts from intraductal papilloma and provide therapeutic options (Fig. 47-1, A). Although great advances have been made in the equipment and success of ductoscopy, its use is still limited to specialized centers. There are several algorithms for the workup of PND, but the most important aspect of the evaluation is to prove that the discharge is not caused by a malignancy (Fig. 47-1, B and C). This often requires surgical resection and pathologic examination of the duct.
Duct Excision
Preoperative Workup
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