Assessment of Utility of Ductal Lavage and Ductoscopy in Breast Cancer—A Retrospective Analysis of Mastectomy Specimens

Abstract

Early detection of breast lesions continues to be an important goal in the management of breast cancer. At present, mammographic imaging in addition to physical examination is the main screening method for the detection of cancer. Fiberoptic ductoscopy and duct lavage are being recently used to evaluate patients at risk for breast cancer. Both techniques examine the nipple and central duct area to identify intraductal lesions. In this study, we examined the frequency of involvement of these structures in mastectomy specimens as a surrogate marker to estimate the utility of these methods in breast Breast cancer is the most frequent type of cancer in women and will affect 1 in 12 women during their lifetime (1). Physical examination and mammographic imaging are the currently used methods for screening for breast cancer. Although larger cancers are easily detected by these methods, smaller tumors can be missed, especially if they arise in densely fibrotic breast tissue. The combination of these screening methods with targeted biopsies ultimately has resulted in earlier detection and treatment of breast cancers. This not only improves patient survival but also decreases the morbidity associated with the disease. Unfortunately, we are still unable to detect a significant number of earlystage cancers. It is for this reason that there is an immense interest in developing new methods for breast cancer screening that would permit detection of carcinoma at an earlier stage, as well as precancerous lesions. Duct lavage and the fiberoptic ductoscopy system are two such methods being evaluated for early detection of breast disease. Duct lavage and fiberoptic ductoscopy involve evaluation of the ductal system of the breast for detection of intraductal carcinomas and precursor lesions such as atypical ductal hyperplasia. At present, breast cancer is believed to originate within the terminal duct lobular units (2, 3) through a succession of events involving and ductal carcinoma in situ (4, 5). Therefore, visual and/or cytological examination of these structures would permit identification of abnormal lesions before the development of invasive disease.Ductal lavage is accomplished with nipple aspiration using a 20-mL syringe (6). If fluid is obtained, the fluid-yielding duct is identified and cannulated.

Comparison of Ductoscopy, Galactography, and Imaging Modalities for the Evaluation of Intraductal Lesions: A Critical Review

“…While only discharged ducts are cannulated by ductoscopy, radiological modalities can detect even intraductal lesions without discharge in asymptomatic patients. 2 studies that examined mastectomy specimens reported that 14-30% of intraductal carcinomas did not have the in situ component [14,73]. These observations raise the possibility that a significant percentage of patients undergoing surgery would not have an intraductal component and therefore MD would not be able to directly visualize some intraductal lesions.…”

“…Researchers were able to depict the lactiferous ducts up to 2-3.3 cm on average, whereby the greatest peripheral depth was 7.5-10 cm [6,8,11,12]. On the other hand, some authors insist on the use of ductoscopy solely for central ducts [13,14]. …”

Biomarker analysis on breast ductal lavage cells in women with and without breast cancer

“…Badve et al published a study that indicated a significant number of cancers do not involve central areas or do not contain a significant intraductal component. 18 Additionally, in most cases only 1 or 2 fluid-yielding ducts per breast can be successfully cannulated from approximately 6-8 ducts present in the nipple of a normal breast. 4,5 For ducts known to harbor cancers, some are not sampled by lavage.…”

Breast Cytology: Current Issues and Future Directions

“…However, several studies have reported low sensitivity of DL in detecting breast carcinoma in patients undergoing mastectomy for carcinoma [85,86]. A plausible explanation is that DL only samples cells from intraductal processes; about 15 to 30% of invasive cancers lack an intraductal components [87,88]. For DL specimens with atypia below the level of malignancy, the clinical significance of such findings is not known.…”