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Patient variables that predict atypical cytology by nipple duct lavage
Zinaida I Bushnaq1, Raheela Ashfaq, A Marilyn Leitch
1Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Background:
Nipple duct lavage (NDL) may be useful for breast cancer risk stratification. Published guidelines recommend that women with a 5-year Gail risk >/=1.7% should consider undergoing lavage for any fluid-yielding ducts, but it is not known whether increased breast cancer risk or nipple fluid production predict lavage atypia.
Methods:
One hundred fifty women unselected for breast cancer risk underwent NDL with cannulation of all nipple aspirate fluid (NAF)-producing ducts and at least 1 dry duct. This resulted in 516 lavage samples. The rate of cytologic atypia was compared for NAF-positive ducts and NAF-negative ducts and for women with 5-year Gail risks >/=1.7% and <1.7%. Ducts from breasts with cancer (N = 113) were excluded from the analysis.
Results:
The cytologic atypia rate was similar for the 240 NAF-producing ducts (19%) and the 163 dry ducts (15%; P = .36). No significant differences were observed when atypia was categorized as mild (13% vs 10%; P = .63) or marked (6% vs 4%; P = .53). Among the 83 patients who were unaffected by breast cancer, atypia was diagnosed in 15 of 44 patients (34%) with a 5-year Gail risk <1.7% and in 11 of 39 patients (28%) with a 5-year Gail risk >/=1.7% (P = .74).
Conclusions:
Neither NAF production nor 5-year Gail risk predicted lavage atypia. Limiting NDL to fluid-producing ducts in women with a 5-year Gail risk >/=1.7% significantly reduced the sensitivity of the test for population screening.
