Ductal lavage may not detect breast cancer


Northwestern Memorial breast surgeon publishes results of pilot study

Ductal lavage is not an effective method for detecting breast cancer, according to a new study led by researchers at Northwestern Memorial Hospital that appears in the October 20 issue of the Journal of the National Cancer Institute.

"This study raises serious questions about the utility of ductal lavage as a cancer detection test and shows us that women should not be offered ductal lavage as a method of breast cancer detection. Mammography and physical examination remain the most effective methods of early detection," explains the study's lead author Seema Khan, M.D., interim director of the Lynn Sage Comprehensive Breast Center and surgeon at Northwestern Memorial Hospital. Dr. Khan adds that "ductal lavage does remain promising as a method for obtaining more information about the level of breast cancer risk."

Ductal lavage is a method that can be used to collect cells that have been shed from the lining of milk ducts from the breast of healthy women, and then examined for early abnormalities. However, it is feasible only when fluid can be expressed from the ducts. On average, only 1 or 2 ducts of the 6-8 that are present in a normal breast will produce fluid. Ductal lavage has been proposed as a screening tool for cancer detection because ducts that yield fluid were thought to be more likely to contain cancer cells. Interest in the procedure was spurred by a study in which ductal lavage detected cancer in four of 11 women who had shown no previous evidence of a malignancy.

To determine the sensitivity and specificity of ductal lavage in the presence of known breast cancer, researchers conducted a pilot study in which ductal lavage was performed prior to mastectomy on 44 breasts from 32 women with known cancer and on eight breasts from seven women undergoing prophylactic mastectomy.

The researchers found poor agreement between a cytologic (cell) analysis of the cells from ductal lavage and results from looking at breast tissue under the microscope. In breasts with cancer, ductal lavage was able to detect only about half of the cancers, possibly because ducts that contain cancer failed to yield fluid or yielded cells classified as benign or mildly atypical. In addition, ducts that produced fluid did not appear to be related to the cancer in about half of the cancer-containing breasts.

In an accompanying editorial, Carol J. Fabian, M.D., of the University of Kansas Medical Center in Kansas City, and colleagues review several other ongoing studies that are attempting to evaluate the utility of ductal lavage. Based on the results of the current study, they conclude, ductal lavage cannot be considered a sensitive screening tool. "Its use as a risk assessment tool and/or as an indicator of response to [a prevention] intervention is still undergoing evaluation," they write.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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