NEW YORKThe lack of fluid yield from cancer-containing breast ducts may
pose a significant barrier to using ductal lavage as a cancer-detection tool in
women with mammographic calcifications, Seema A. Khan, MD, reported at the 57th
Annual Cancer Symposium of the Society of Surgical Oncology (abstract 29). In a
study of 20 patients with mammographic calcifications, there were 10 cases of
ductal carcinoma in situ (DCIS), of which only 3 (30%) yielded fluid. "This is
not a technique that should be offered to women with the hope that we might
detect occult cancer," said Dr. Khan, director, Bluhm Family Breast Cancer
Early Detection and Prevention Program, Northwestern Memorial Hospital.
Ductal lavage once held great promise as a potential method for cytological
diagnosis of occult malignancies in the breast. These latest findings, however,
follow earlier data discounting the promise of ductal lavage for detecting
larger tumors, in a study also conducted by Dr. Khan and colleagues in 40 women
with invasive cancers and DCIS (J Natl Cancer Instit, in press).
While the results are not encouraging, Dr. Khan said she was not yet ready
to write off the potential for using this technology to diagnose breast cancer,
since both of the studies were small.
In their previous study, Dr. Khan and her colleagues investigated the
premise that ductal lavage could be used to detect known cancers in 40 women
undergoing mastectomy. Results showed a specificity that was encouraging,
according to Dr. Khan, but a "relatively poor" sensitivity ranging from 16% to
In that study, which included patients with large, palpable cancers (mean
size of the invasive component, 3.2 cm), cancer detection was greater for
earlier lesions. "The likelihood of detecting cancer using ductal lavage is far
greater if there is significant DCIS, since the technique detects intraductal
neoplasia," Dr. Khan explained.
Thus, the study presented at the Society of Surgical Oncology meeting looked
at the "other end of the spectrum": women with microcalcifications (BIRADS 4 or
5) detected on screening. The 20 women in the study were scheduled to have
ductal lavage prior to planned biopsy.
The lavage catheter was left in the duct, and radiographic contrast was
instilled to the duct through the same catheter to confirm that the duct
lavaged overlapped the area of calcification. If the duct did not overlap and
there were additional fluid-yielding ducts, those additional ducts were lavaged
to the extent possible. However, there were some constraints "related to
patient willingness to undergo this procedure repeatedly, as well as timing and
scheduling in the radiology suite," Dr. Khan reported.