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

Patil, Deepa B; Lankes, Heather A.; Nayar, Ritu; Masood, Shahla; Bryk, Michelle; Hou, Nanjiang; Rademaker, Alfred; Khan, Seema A.

doi:10.1007/s10549-007-9861-8

Cited by 19 publications

(13 citation statements)

References 12 publications

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“…In accordance with recent surveys atypical hyperplasia of the breast ductal epithelium is associated with an increased risk of subsequent development of BC [12-15]. In this prospective study we report cytologic examination of NAF samples collected from otherwise asymptomatic healthy women with DL.…”

Section: Discussionsupporting

confidence: 60%

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

Konstandiadou¹,

Mastoraki²,

Kotsilianou³

et al. 2012

J Gynecol Oncol

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ObjectiveDuctal 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.MethodsInto 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.ResultsNinety 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.ConclusionDL 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.

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Section: Discussionsupporting

confidence: 60%

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

Konstandiadou¹,

Mastoraki²,

Kotsilianou³

et al. 2012

J Gynecol Oncol

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“…Successful repeated cannulation of the same duct with very high efficiency (97%), 6 months following the first cannulation, has been reported in disease free, high-risk women in a chemoprevention setting [18]. Diseased ducts have been accessed successfully by cannulation for ductal lavage or ductoscopy as shown by us and others [14, 19–21].…”

Section: Discussionmentioning

confidence: 95%

Effective treatment of ductal carcinoma in situ with a HER-2-targeted alpha-particle emitting radionuclide in a preclinical model of human breast cancer

et al. 2016

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The standard treatment for ductal carcinoma in situ (DCIS) of the breast is surgical resection, followed by radiation. Here, we tested localized therapy of DCIS in mice using the immunoconjugate 225Ac linked-trastuzumab delivered through the intraductal (i.duc) route. Trastuzumab targets HER-2/neu, while the alpha-emitter 225Ac (half-life, 10 days) delivers highly cytotoxic, focused doses of radiation to tumors. Systemic 225Ac, however, elicits hematologic toxicity and at high doses free 213Bi, generated by its decay, causes renal toxicity. I.duc delivery of the radioimmunoconjugate could bypass its systemic toxicity. Bioluminescent imaging showed that the therapeutic efficacy of intraductal 225Ac-trastuzumab (10-40 nCi per mammary gland; 30-120 nCi per mouse) in a DCIS model of human SUM225 cancer cells in NSG mice was significantly higher (p<0.0003) than intravenous (120 nCi per mouse) administration, with no kidney toxicity or loss of body weight. Our findings suggest that i.duc radioimmunotherapy using 225Ac-trastuzumab deserves greater attention for future clinical development as a treatment modality for early breast cancer.

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“…When ducts are found on lavage to have atypia, repeat lavage often fails to demonstrate atypia a second time. 11,14,15 The concordance between NAF cytology and breast pathology also may be unreliable. Only 16.6% of samples from malignant breasts contained an abnormality in the study by Wood et al 12 Khan et al found ductal lavage to have a sensitivity of only 13–42% in breasts with known cancers.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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Objectives The study was designed to determine which histological lesions produce cellular atypia in lavage specimens and whether ductoscopy adds useful information for the evaluation of high-risk patients with atypical lavage cytology. Methods We prospectively recruited women ≥35 years at high risk for developing breast cancer. All underwent ductal lavage. Women found to have atypia underwent ductoscopy-directed duct excision (group 1). Women without atypia were observed (group 2). Data included patient demographics, risk assessment, cytologic and histologic findings, and outcomes. Descriptive statistics were utilized for data summary and were compared using Fisher’s exact test. Results We enrolled 102 women; 93 (91%) were Caucasian. Their median age was 49 (range 34–73) years with a median follow-up of 80 (range 5–90) months. Overall, 27 (26%) had atypical lavage cytology (group 1), and 75 (74%) had benign cytology (group 2). Subsequent duct excision in group 1 revealed benign histology in 11 (44%), papillomas in 9 (36%), atypical hyperplasia (AH) in 4 (16%), and ductal carcinoma in situ (DCIS) in 1 (4%). At follow-up, three patients developed breast cancer, including one group 1 patient and two group 2 patients. There were no differences between groups 1 and 2 according to patient demographics, Gail scores, or risk for subsequent breast cancer (P >0.05). Conclusions Although 20% of high-risk women with ductal lavage atypia have AH or malignancy on subsequent excision, the majority do not. Atypia identified by ductal lavage is not associated with a higher risk of developing subsequent breast cancer, even in this high-risk population.

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

Cited by 19 publications

References 12 publications

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

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

Effective treatment of ductal carcinoma in situ with a HER-2-targeted alpha-particle emitting radionuclide in a preclinical model of human breast cancer

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

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