title: Multiple sampling for increasing the diagnostic sensitivity of nipple aspirate fluid for atypical cytology.
abstract: OBJECTIVE
  To determine if repeated collection of nipple aspirate fluid (NAF) can improve the diagnostic sensitivity for cytologic atypia, a marker of increased risk of breast cancer.
  
  
  METHODS
  Two hundred sixty-seven women without known breast disease volunteered for NAF cytology at 5 6-month intervals over 2 years. NAF samples were prepared on Millipore filters (Millipore Filter Corp., Bedford, Massachusetts, U.S.A.) and stained with a modified Papanicolaou method. Fluid availability and cellular abnormalities were evaluated for each collection attempt. Cellular findings were classified as benign, hyperplasia or atypia.
  
  
  RESULTS
  NAF was obtained from 178 women (66.6%) at the first visit and from an additional 15, 10, 2 and 4 women at visits 2, 3, 4 and 5, respectively, for a cumulative total of 78.2% by visit 5. The number of women yielding NAF containing hyperplastic or atypical epithelial cells was determined at each visit. Hyperplastic cells were found in 34 (19.1%) at visit 1 and in an additional 20, 10, 5 and 4 women at visits 2, 3, 4 and 5, respectively. Atypical epithelial cells were present in 12 (6.7%) women at the initial visit and in an additional 11, 7, 5 and 1 women at visits 2, 3, 4 and 5, respectively, for a cumulative percent of 18.2 at visit 5. NAF could not be obtained from 58 women at any visit.
  
  
  CONCLUSIONS
  These findings suggest that an optimum collection method for NAF cytology should consist of at least 3 or 4 separate fluid aspiration attempts. Reviewing repeated multiple samples instead of 1 increases the number of women who can be evaluated and the likelihood of detecting cytologic atypia.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California 94143-0560, USA.
authors.forename: Eileen B
authors.initials: EB
authors.lastname: King
authors.forename: Karen L
authors.initials: KL
authors.lastname: Chew
authors.forename: John D
authors.initials: JD
authors.lastname: Hom
authors.forename: Rei
authors.initials: R
authors.lastname: Miike
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Wrensch
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Petrakis
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods / Q000592:standards*; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000473:pathology*; D003951:Diagnostic Errors / Q000517:prevention & control*; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D042361:Mammary Glands, Human / Q000378:metabolism / Q000473:pathology; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D009558:Nipples / Q000378:metabolism; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity