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Ductal Lavage Identifies Patients for Chemoprevention

Ductal Lavage Identifies Patients for Chemoprevention

ORLANDO—The routine use of ductal lavage in a high-risk breast surgical
oncology practice will identify many patients who may benefit substantially
from chemoprevention with tamoxifen (Nolvadex), and may detect rare
contralateral breast cancers missed by traditional methods, according to a
report at the 38th Annual Meeting of the American Society of Clinical Oncology
(abstract 193).

William C. Dooley, MD, professor of surgery and medical director of the
Institute for Breast Health at the University of Oklahoma Health Sciences
Center, reported on 77 women who underwent intraoperative ductal lavage. The
study included 68 patients undergoing surgery for stage 0-II primary breast
cancer; 5 patients with elevated breast cancer risk by the Gail model who
underwent microductectomy for pathologic nipple discharge; and 4 patients who
underwent re-excision of core-biopsy-proven atypical ductal or lobular
hyperplasia.

All patients had at least one fluid-producing duct in the normal
contralateral breast, which was successfully cannulated for ductal lavage in
the operating room at the time of the surgical procedure. Cytologic diagnoses
from the contralateral procedure revealed 19 patients (25%) with atypia, 16
(21%) with a hypocellular specimen, and 42 (55%) with benign cells.

In 15 patients with the finding of contralateral atypia—78% of all patients
with atypia and 19% of all 77 patients—this information changed the management
of the patient’s breast disease. This was usually the addition of tamoxifen as
a chemo-preventive strategy where it would not have been prescribed without the
information from the contralateral breast, Dr. Dooley reported.

In one case, the finding of atypia led to the diagnosis of an occult
malignancy that was clinically and radiologically unsuspected.

The study adds to data from a previous larger multicenter study in which
these authors participated. In that study, ductal lavage in high-risk women
revealed abnormal cells in 93 of 383 women (24%). The abnormal cytology fell
into the following categories: 17% mildly atypical, 6% markedly atypical, and
0.5% malignant.

Ductal lavage resulted in the collection of significantly more ductal
epithelial cells than did the traditional collection method of nipple
aspiration with a manual suction cup. The rate of adequate specimen collection
and the diagnostic sensitivity were significantly higher with ductal lavage;
fluid-yielding ducts were identified in 84% of subjects; and the concordance
with the initial independent cytologic diagnosis was 89%.

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