Patient and duct selection for nipple duct lavage.
BACKGROUND
Nipple ductal lavage (NDL) is a new minimally invasive procedure with the potential to help identify women who could benefit from breast cancer risk intervention. NDL is currently encouraged for women with fluid-producing ducts and a 5-year Gail risk > or =1.7%. The purpose of this study was to evaluate the atypia rate by NDL in fluid-producing ducts compared with non-fluid-producing ducts and the atypia rate in high-risk verses low-risk patients to determine if current recommendations are supported.


METHODS
Fifty-nine women were studied with NDL. The 226 ducts lavaged included all fluid-producing ducts (n = 136) and any dry ducts we could cannulate (n = 90). Breast cancer risk was calculated using mathematic models.


RESULTS
There were 26 (44%) women with a 5-year Gail risk > or =1.7% and 33 (56%) with a 5-year Gail risk <1.7%. Cytologic atypia was diagnosed in 20 of 59 (34%) of patients. The atypia rate was similar for women with a 5-year Gail risk > or =1.7% (9 of 26 or 35%) compared with lower-risk women (11 of 33 or 33%, P = 1.0) and for fluid-producing ducts (26 of 136 or 19%) compared with dry ducts (14 of 90 or 15%, P = 0.61). No significant differences were found when the atypia was categorized as mild versus marked. Of note, the insufficient sample rate was higher for dry ducts (33%) compared with fluid-producing duct (22%, P = 0.07).


CONCLUSIONS
If NDL results are found to correlate with breast cancer incidence, it will be important to apply the test in a way that maximizes sensitivity for the detection of atypia in a screened population. We were unable to identify patient or duct characteristics that predict NDL atypia rates.
Department of Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9155, USA.
April Johnson
AJ
Maddux
Raheela
R
Ashfaq
Elizabeth
E
Naftalis
Ann Marilyn
AM
Leitch
Susan
S
Hoover
David
D
Euhus
D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009558:Nipples; D018579:Patient Selection; D012307:Risk Factors; D007507:Therapeutic Irrigation