J Gynecol Oncol.  2012 Apr;23(2):110-114. 10.3802/jgo.2012.23.2.110.

Does ductal lavage assert its role as a noninvasive diagnostic modality to identify women at low risk of breast cancer development?

• Konstandiadou I
• Mastoraki
• Kotsilianou O
• Karakitsos P
• Athanasas
• Smyrniotis V
• Arkadopoulos N

• KMID: 2177584
• DOI: http://doi.org/10.3802/jgo.2012.23.2.110

Abstract

OBJECTIVE
Ductal lavage (DL) involves evaluation of the ductal system of the breast for detection of intra-ductal carcinomas and precursor lesions by collecting breast epithelial cells using a small-gauge catheter inserted into a ductal orifice on the nipple. The aim of this survey was to analyze cytologic features of samples obtained from low-risk women with DL and to elucidate the efficacy of this diagnostic modality in evaluating fluid production, cannulating and determining atypical breast epithelial cells.
METHODS
Into this prospective study were consecutively registered 80 women between ages 28 to 67. Nipple aspiration was performed to identify all fluid-yielding ducts. According to the grading of specific features the interpretation of the sample included: normal/benign (category, 0), mild atypical (category, I), markedly atypical (category, II) or malignant (category, III) disorders.
RESULTS
Ninety five percent (316/334) of the nipple aspirate fluid samples were classified as category 0, 4.8% (16/334) as category I and 0.2% (2/334) as category II changes. Category III disorders were not detected. Therefore, in 80% of the women examined results were within normal limits while 17.5% of the participants presented mild atypical and 2.5% markedly atypical rates.
CONCLUSION
DL collection procedure proved to be rapid as well as acceptable by the women studied. It retains the advantage over other methods of nipple aspirate fluid in that it is easy to perform, thereby removing most clinician variability. It also helped low risk women to discriminate those with breast disorders that require additional investigation, further follow-up or administration of preventive medication.

Keyword

Breast neoplasms; Cytology; Ductal lavage; Nipple aspirate fluid

MeSH Terms

Breast
Breast Neoplasms
Catheters
Epithelial Cells
Female
Humans
Imidazoles
Nipple Aspirate Fluid
Nipples
Nitro Compounds
Prospective Studies
Therapeutic Irrigation
Imidazoles
Nitro Compounds

Reference

1. Sathiakumar N, Delzell E, Morrisey MA, Falkson C, Yong M, Chia V, et al. Mortality following bone metastasis and skeletal-related events among women with breast cancer: a population-based analysis of U.S. Medicare beneficiaries, 1999-2006. Breast Cancer Res Treat. 2012. 131:231–238.

2. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006. 56:106–130.

3. Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin. 2006. 56:168–183.

4. Hollingsworth AB, Singletary SE, Morrow M, Francescatti DS, O'Shaughnessy JA, Hartman AR, et al. Current comprehensive assessment and management of women at increased risk for breast cancer. Am J Surg. 2004. 187:349–362.

5. Pinder SE, Ellis IO. The diagnosis and management of preinvasive breast disease: ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) - current definitions and classification. Breast Cancer Res. 2003. 5:254–257.

6. King EB, Chew KL, Petrakis NL, Ernster VL. Nipple aspirate cytology for the study of breast cancer precursors. J Natl Cancer Inst. 1983. 71:1115–1121.

7. Baltzell KA, Moghadassi M, Rice T, Sison JD, Wrensch M. Epithelial cells in nipple aspirate fluid and subsequent breast cancer risk: a historic prospective study. BMC Cancer. 2008. 8:75.

8. Maddux AJ, Ashfaq R, Naftalis E, Leitch AM, Hoover S, Euhus D. Patient and duct selection for nipple duct lavage. Am J Surg. 2004. 188:390–394.

9. Buehring GC, Letscher A, McGirr KM, Khandhar S, Che LH, Nguyen CT, et al. Presence of epithelial cells in nipple aspirate fluid is associated with subsequent breast cancer: a 25-year prospective study. Breast Cancer Res Treat. 2006. 98:63–70.

10. Dooley WC, Ljung BM, Veronesi U, Cazzaniga M, Elledge RM, O'Shaughnessy JA, et al. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst. 2001. 93:1624–1632.

11. O'Shaughnessy JA, Ljung BM, Dooley WC, Chang J, Kuerer HM, Hung DT, et al. Ductal lavage and the clinical management of women at high risk for breast carcinoma: a commentary. Cancer. 2002. 94:292–298.

12. Patil DB, Lankes HA, Nayar R, Masood S, Bryk M, Hou N, et al. Reproducibility of ductal lavage cytology and cellularity over a six month interval in high risk women. Breast Cancer Res Treat. 2008. 112:327–333.

13. Visvanathan K, Santor D, Ali SZ, Brewster A, Arnold A, Armstrong DK, et al. The reliability of nipple aspirate and ductal lavage in women at increased risk for breast cancer: a potential tool for breast cancer risk assessment and biomarker evaluation. Cancer Epidemiol Biomarkers Prev. 2007. 16:950–955.

14. Wrensch MR, Petrakis NL, Miike R, King EB, Chew K, Neuhaus J, et al. Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid. J Natl Cancer Inst. 2001. 93:1791–1798.

15. London SJ, Connolly JL, Schnitt SJ, Colditz GA. A prospective study of benign breast disease and the risk of breast cancer. JAMA. 1992. 267:941–944.

16. Khan SA, Baird C, Staradub VL, Morrow M. Ductal lavage and ductoscopy: the opportunities and the limitations. Clin Breast Cancer. 2002. 3:185–191.

17. Loud JT, Beckjord EB, Nichols K, Peters J, Giusti R, Greene MH. Tolerability of breast ductal lavage in women from families at high genetic risk of breast cancer. BMC Womens Health. 2009. 9:20.

18. Khan SA, Lankes HA, Patil DB, Bryk M, Hou N, Ivancic D, et al. Ductal lavage is an inefficient method of biomarker measurement in high-risk women. Cancer Prev Res (Phila). 2009. 2:265–273.

19. Tice JA, Miike R, Adduci K, Petrakis NL, King E, Wrensch MR. Nipple aspirate fluid cytology and the Gail model for breast cancer risk assessment in a screening population. Cancer Epidemiol Biomarkers Prev. 2005. 14:324–328.

20. Cyr AE, Margenthaler JA, Conway J, Rastelli AL, Davila RM, Gao F, et al. Correlation of ductal lavage cytology with ductoscopy-directed duct excision histology in women at high risk for developing breast cancer: a prospective, single-institution trial. Ann Surg Oncol. 2011. 18:3192–3197.

21. Dubowy A, Raubach M, Topalidis T, Lange T, Eulenstein S, Hunerbein M. Breast duct endoscopy: ductoscopy from a diagnostic to an interventional procedure and its future perspective. Acta Chir Belg. 2011. 111:142–145.