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Breast Ductal Lavage

Part of the Essentials in Cytopathology book series (EICP, volume 4)

Abstract

To obtain nipple aspiration fluid (NAF), a pump and/or a syringe connected to a suction cup is applied to the nipple and the aspirated fluid is collected using a capillary tube. This procedure yields NAF in 59%–99% of women. A volume of 20–30μl of fluid can be obtained (range 1–200). About 77% of the cells of NAF are foam cells of macrophage derivation, and only 13% are ductal epithelial cells (median 120 cells/ duct). Criteria for evaluation of NAF were developed in the mid-1970s and are similar to the criteria used for evaluation of breast FNA material. The cytologic findings in NAF from 2,701 volunteer women with no family history of breast cancer and no breast carcinoma at the time of enrollment were analyzed prospectively. The overall incidence of breast cancer in this cohort was 4.4% after median follow-up of 12.7 years. In this study, both incidence and relative risk of breast cancer increased with increasing severity of cytologic diagnosis of the NAF (Table 6.1). Although the relative risk of breast cancer associated with abnormal NAF was reduced in an updated analysis of the data, these results have generated much interest in the use of mammary cytology for the evaluation of breast cancer risk.

Keywords

Breast Cancer Risk Ductal Cell Atypical Ductal Hyperplasia Ductal Lavage Usual Ductal Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Selected Reading

  1. Brogi E, Miller MJ, Casadio C, Ljung B-M, Montgomery L: Paired ductal lavage and fine needle aspiration specimens from patients with breast carcinoma. Diagn Cytopathol 2005, 33: 370–375.PubMedCrossRefGoogle Scholar
  2. Brogi E, Robson M, Panageas KS, Casadio C, Ljung BM, Montgomery L: Ductal lavage in patients undergoing mastectomy for mammary carcinoma: a correlative study. Cancer 2003, 98: 2170–2176.PubMedCrossRefGoogle Scholar
  3. Dooley WC, Ljung BM, Veronesi U, Cazzaniga M, Elledge RM, O’Shaughnessy JA, Kuerer HM, Hung DT, Khan SA, Phillips RF, Ganz PA, Euhus DM, Esserman LJ, Haffty BG, King BL, Kelley MC, Anderson MM, Schmit PJ, Clark RR, Kass FC, Anderson BO, Troyan SL, Arias RD, Quiring JN, Love SM, Page DL, King EB: Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst 2001, 93:1624–1632.PubMedGoogle Scholar
  4. Johnson-Maddux A, Ashfaq R, Cler L, Naftalis E, Leitch AM, Hoover S, Euhus DM: Reproducibility of cytologic atypia in repeat nipple duct lavage. Cancer 2005, 103:1129–1136.PubMedCrossRefGoogle Scholar
  5. Khan SA, Wiley EL, Rodriguez N, Baird C, Ramakrishnan R, Nayar R, Bryk M, Bethke KB, Staradub VL, Wolfman J, Rademaker A, Ljung BM, Morrow M: Ductal lavage findings in women with known breast cancer undergoing mastectomy. J Natl Cancer Inst 2004, 96:1510–1517.PubMedCrossRefGoogle Scholar
  6. King EB, Barrett D, King MC, Petrakis NL: Cellular composition of the nipple aspirate specimen of breast fluid. I. The benign cells. Am J Clin Pathol 1975, 64:728–738.PubMedGoogle Scholar
  7. King EB, Barrett D, Petrakis NL: Cellular composition of the nipple aspirate specimen of breast fluid. II. Abnormal findings. Am J Clin Pathol 1975, 64:739–748.PubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. King BL, Crisi GM, Tsai SC, Haffty BG, Phillips RF, Rimm DL: Immunocytochemical analysis of breast cells obtained by ductal lavage. Cancer 2002, 96:244–249.PubMedCrossRefGoogle Scholar
  10. Krassenstein R, Sauter E, Dulaimi E, Battagli C, Ehya H, Klein-Szanto A, Cairns P: Detection of breast cancer in nipple aspirate fluid by CpG island hypermethylation. Clin Cancer Res 2004, 10:28–32.PubMedCrossRefGoogle Scholar
  11. Krishnamurthy S, Sneige N, Ordonez NG, Hunt KK, Kuerer HM: Characterization of foam cells in nipple aspirate fluid. Diagn Cytopathol 2002, 27:261–265.PubMedCrossRefGoogle Scholar
  12. Ljung BM, Chew KL, Moore DH, 2nd, King EB: Cytology of ductal lavage fluid of the breast. Diagn Cytopathol 2004, 30:143–150.PubMedCrossRefGoogle Scholar
  13. National Cancer Institute: The uniform approach to breast fine-needle aspiration biopsy. National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees. Diagn Cytopathol 1997, 16:295–311.CrossRefGoogle Scholar
  14. Sartorius OW, Smith HS, Morris P, Benedict D, Friesen L: Cytologic evaluation of breast fluid in the detection of breast disease. J Natl Cancer Inst 1977, 59:1073–1080.PubMedGoogle Scholar
  15. Sauter ER, Ehya H, Schlatter L, MacGibbon B: Ductoscopic cytology to detect breast cancer. Cancer J 2004, 10:33–41; discussion 15-36.PubMedCrossRefGoogle Scholar
  16. Sauter ER, Ross E, Daly M, Klein-Szanto A, Engstrom PF, Sorling A, Malick J, Ehya H: Nipple aspirate fluid: a promising non-invasive method to identify cellular markers of breast cancer risk. Br J Cancer 1997, 76:494–501.PubMedGoogle Scholar
  17. Wrensch MR, Petrakis NL, King EB, Miike R, Mason L, Chew KL, Lee MM, Ernster VL, Hilton JF, Schweitzer R, et al.: Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid. Am J Epidemiol 1992, 135:130–141.PubMedGoogle Scholar
  18. Zhu W, Qin W, Ehya H, Lininger J, Sauter E: Microsatellite changes in nipple aspirate fluid and breast tissue from women with breast carcinoma or its precursors. Clin Cancer Res 2003, 9:3029–3033.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2007

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