title: Ductal lavage findings in women with known breast cancer undergoing mastectomy.
abstract: BACKGROUND
  Ductal lavage has the potential to detect cancer by sampling breast epithelium in asymptomatic high-risk women. To assess the utility of ductal lavage as a cancer diagnostic test, we investigated the association between ductal lavage cytologic findings and histologic findings in women with known breast cancer undergoing mastectomy.
  
  
  METHODS
  Ductal lavage was performed in the operating room before mastectomy on 44 breasts from 32 women with known cancer and on eight breasts from seven women undergoing prophylactic mastectomy, two with occult malignancy. If the ductal lavage sample from one or more ducts contained enough epithelial cells for a cytologic diagnosis, lavaged ducts were injected with a mixture of colored dye, gelatin, and a radiographic contrast compound after mastectomy, and breast tissue was radiographed and sectioned. Histologic findings in ducts with and without dye were recorded. Associations between cytologic results and histologic results were examined by univariate and multivariable analyses.
  
  
  RESULTS
  At least one duct was lavaged in 36 breasts (mean = 1.4 ducts per breast); all histologic and cytologic procedures were completed in 28 breasts and in 39 ducts. Markedly atypical or malignant cytology was found in five cancer-containing breasts. In 39 ducts with complete cytologic and histologic data and when marked atypia or malignant cells defined a positive cytologic test, sensitivity was 43% (95% confidence interval [CI] = 23% to 72%), specificity was 96% (95% CI = 86% to 100%), and accuracy was 77% (95% CI = 63% to 89%). When mild or marked atypia or malignant cells defined a positive cytologic test, sensitivity was 79% (95% CI = 57% to 96%), specificity was 64% (95% CI = 46% to 83%), and accuracy was 69% (95% CI = 55% to 83%). When all 31 cytologically evaluable breasts were analyzed, sensitivity was 17% (95% CI = 7% to 35%), specificity was 100% (95% CI = 5% to 100%), and accuracy was 19% (95% CI = 9% to 38%).
  
  
  CONCLUSIONS
  In breasts with cancer, ductal lavage appears to have low sensitivity and high specificity for cancer detection, possibly because cancer-containing ducts fail to yield fluid or have benign or mildly atypical cytology.
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL, USA. skhan@nmh.org
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Wiley
authors.forename: Norma
authors.initials: N
authors.lastname: Rodriguez
authors.forename: Carol
authors.initials: C
authors.lastname: Baird
authors.forename: Rathi
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Ritu
authors.initials: R
authors.lastname: Nayar
authors.forename: Michele
authors.initials: M
authors.lastname: Bryk
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Bethke
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Staradub
authors.forename: Judith
authors.initials: J
authors.lastname: Wolfman
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ljung
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology*; D008408:Mastectomy; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011322:Primary Prevention; D012107:Research Design; D012680:Sensitivity and Specificity; D007507:Therapeutic Irrigation