Abstract
Background
We designed a prospective study to assess the likelihood that early lesions presenting as mammographic calcifications could be accessed for cytological diagnosis by ductal lavage (DL).
Methods
Consenting women with calcifications (Breast Imaging Reporting and Data System 4 or 5) underwent DL of fluid-yielding ducts (FYDs) before stereotactic core or excisional biopsy. The DL catheter was used to inject .2 to 1 mL of Isovue 300 into the duct to determine whether the FYD corresponded to the duct containing calcifications (designated overlap). Additional FYDs were injected, if possible, until overlap was identified. DL cytology was compared with histology.
Results
Twenty women were enrolled (mean age, 54.2 years); the mean size of the calcification-bearing area was 190 mm2. The histological findings were as follows: 1 invasive cancer, 9 ductal carcinomas-in-situ (DCIS), 5 atypical hyperplasias, and 5 usual hyperplasias or fibrocystic changes. Four women had no FYD. In 15 women who underwent DL and ductography, overlap of dye and calcifications was seen in 4 (27%): 1 fibrocystic change, 1 hyperplasia, 1 atypical hyperplasia (cytological diagnosis mildly atypical), and 1 DCIS (cytological diagnosis benign). Of the remaining 8 DCIS lesions, 4 had no nipple aspiration fluid, 1 showed extravasation, and 3 were lavaged but the duct did not overlap.
Conclusions
These results are consistent with data from women undergoing mastectomy for larger invasive cancer and DCIS and show that cancer-containing ducts do not yield nipple fluid in most cases.
Similar content being viewed by others
References
Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002;225:165–75
Porter PL, El Bastawissi AY, Mandelson MT, et al. Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 1999;91:2020–8
Dooley WC, Ljung B-M, Veronesi U, et al. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst 2001;93:1624–32
Khan SA, Rodriguez N, Baird C, et al. Ductal lavage findings in women with known breast cancer undergoing mastectomy (abstract). Breast Cancer Res Treat 2002;76(Suppl 1):S35
Khan SA, Wiley EL, Rodriguez N, et al. Ductal lavage findings in women with known breast cancer undergoing mastectomy. J Natl Cancer Inst 2004;96:1510–7
The uniform approach to breast fine needle aspiration biopsy. A synopsis. Acta Cytol 1996;40:1120–6
Papanicolaou GN, Holmquist DG, Bader GM, Falk EA. Exfoliative cytology of the human mammary gland and its value in the diagnosis of cancer and other diseases of the breast. Cancer 1958;11:377–409
Sartorius OW, Smith HS, Morris P, Benedict D, Friesen L. Cytologic evaluation of breast fluid in the detection of breast disease. J Natl Cancer Inst 1977;59:1073–80
Sartorius OW, Morris PL, Benedict DL, Smith HS. Contrast ductography for recognition and localization of benign and malignant breast lesions: an improved technique. In: Logan WW, ed. Breast Cancer. New York: Wiley, 1977: 281–300
Wrensch MR, Petrakis NL, King EB, et al. Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid. Am J Epidemiol 1992;135:130–41
Wrensch MR, Petrakis NL, Miike R, et al. Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid. J Natl Cancer Inst 2001;93:1791–8
Brogi E, Robson M, Panageas KS, Casadio C, Ljung BM, Montgomery L. Ductal lavage in patients undergoing mastectomy for mammary carcinoma: a correlative study. Cancer 2003;98:2170–6
King BL, Tsai SC, Gryga ME, et al. Detection of chromosomal instability in paired breast surgery and ductal lavage specimens by interphase fluorescence in situ hybridization. Clin Cancer Res 2003;9:1509–16
Acknowledgments
Supported by the Bluhm Family Breast Cancer Early Detection and Prevention Program, Specialized Program of Research Excellence grant P50-CA89018, and the Cytyc Corporation.
Author information
Authors and Affiliations
Corresponding author
Additional information
Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.
Rights and permissions
About this article
Cite this article
Khan, S.A., Wolfman, J.A., Segal, L. et al. Ductal Lavage Findings in Women With Mammographic Microcalcifications Undergoing Biopsy. Ann Surg Oncol 12, 689–696 (2005). https://doi.org/10.1245/ASO.2005.04.037
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2005.04.037