Ductal lavage and the clinical management of women at high risk for breast carcinoma

Abstract

B reast carcinoma arises in the epithelial cells lining the milk ducts and lobules that comprise the ductal system of the breast. 1,2 Ductal lavage is a minimally invasive office procedure performed on women who are considered to be at high risk for breast carcinoma to collect breast ductal epithelial cells for cytologic analysis to provide further risk stratification. The procedure involves the insertion of a microcatheter approximately 1.5 cm into a nipple orifice after topical anesthesia; lavaging the cannulated ductal system with normal saline; and analyzing the collected lavage effluent for the presence of normal, atypical, or malignant breast ductal cells.The purpose of this commentary is to review the data supporting breast ductal cytology as a tool to provide high-risk women with individualized information regarding their risk of developing breast carcinoma, and to provide a discussion of clinical management options based on the results of ductal lavage cytology. Significance of Atypical Ductal Epithelial CellsPublished, peer-reviewed data with long-term follow-up have demonstrated that women with atypical ductal epithelial cells have an elevated, near-term risk of developing breast carcinoma. Wrensch et al. collected ductal epithelial cells from 2701 women volunteers by nipple aspiration, analyzed those cells cytologically, and performed prospective longitudinal follow-up on 2343 women with an average follow-up period of 12.7 years. 3 This study demonstrated that women with cellular atypia in nipple aspirate fluid (NAF) had a relative risk of developing breast carcinoma that was 4.9 times greater than women whose breasts did not yield NAF. Women with a family history of breast carcinoma and cellular atypia on NAF had an increase in their relative risk that was 18 times greater than that for women without cellular atypia on NAF. 3 292

Reproducibility of ductal lavage cytology and cellularity over a six month interval in high risk women

“…Ductal lavage (DL) is a method of minimally invasive breast epithelial sampling which has been proposed for further risk stratification of high risk women, and for serial observation and repeat biomarker analysis in prevention studies [1][2][3]. When introduced, it was postulated to have advantages over existing methods of breast epithelial sampling, such as nipple aspiration fluid (NAF) and random fine needle aspiration (rFNA).…”

Breast conservation: Current results and future perspectives at the European Institute of Oncology

“…Approaches such as gene-expression profiling will increasingly be used to determine whether breast cell anomalies are premalignant. 22 …”

Reproducibility of cytologic atypia in repeat nipple duct lavage

“…7,8 many of the basic performance characteristics of the procedure remain unknown. A multiinstitutional study comparing NDL with NAF found that the insufficient sample rate was much lower for NDL than for NAF (22% vs. 73%) and that the atypia rate was much higher (24% vs. 10%).…”