title: Technical enhancements to breast ductal lavage.
abstract: BACKGROUND
  Ductal lavage is a technique that samples the contents of breast ducts for research into the biology of breast cancer. Enthusiasm for this method has declined because of technical challenges associated with the procedure. These include: difficulty in duct cannulation, high levels of subject discomfort, and an inability to confirm perforation.
  
  
  METHODS
  As part of a larger institutional review board (IRB)-approved study, consenting healthy women underwent ductal lavage of 3-4 ducts in one breast. Intranipple lidocaine was administered before duct cannulation. Ductoscopy was performed prior to catheterization and high-definition ultrasound was used for imaging during the lavage procedure. Pain scores were recorded at 24 hours and 2 weeks. Subjects were asked to return in 6 months for a repeat of the procedure.
  
  
  RESULTS
  Ductoscopy was performed prior to lavage under real-time ultrasound 308 times in 107 subjects. There were 280 confirmed ducts (90.9%) and 21 perforations (6.8%), while seven (2.3%) were indeterminate. Subjects reported minimal discomfort, and 91% reported a 0 (0-10 range) pain score 2 weeks after the procedure. The retention rate was 90% at 6 months.
  
  
  CONCLUSIONS
  The injection of lidocaine directly into the nipple greatly increases the feasibility of duct cannulation and improves subject comfort. Confirmation of duct cannulation and lavage can be documented with ductoscopy and ultrasound imaging. These procedures can be added to ductal lavage to facilitate its use as a research tool.
authors.affiliation: Dr. Susan Love Research Foundation, 2811 Wilshire Boulevard, Suite 500, Santa Monica, CA, 90403, USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Tondre
authors.forename: Mitra
authors.initials: M
authors.lastname: Nejad
authors.forename: Ashley
authors.initials: A
authors.lastname: Casano
authors.forename: Dixie
authors.initials: D
authors.lastname: Mills
authors.forename: Susan
authors.initials: S
authors.lastname: Love
mesh_terms: D000779:Anesthetics, Local; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D003581:Cytodiagnosis / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008012:Lidocaine; D009558:Nipples / Q000473:pathology*; D010147:Pain Measurement
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine