title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. cyra@wudosis.wustl.edu
authors.forename: Amy E
authors.initials: AE
authors.lastname: Cyr
authors.forename: Julie A
authors.initials: JA
authors.lastname: Margenthaler
authors.forename: Jill
authors.initials: J
authors.lastname: Conway
authors.forename: Antonella L
authors.initials: AL
authors.lastname: Rastelli
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Davila
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Jill R
authors.initials: JR
authors.lastname: Dietz
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D012634:Bodily Secretions / Q000166:cytology*; D001940:Breast / Q000378:metabolism / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000601:surgery; D003581:Cytodiagnosis; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies