Reproducibility of cytologic atypia in repeat nipple duct lavage

April Johnson-Maddux, Raheela Ashfaq, Leslie Cler, Elizabeth Naftalis, Ann Marilyn Leitch, Susan Hoover, David M. Euhus

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND. It is believed that atypical cells identified by nipple duct lavage (NDL) indicate an increased risk for breast carcinoma similar to atypical ductal hyperplasia diagnosed by tissue biopsy, but many basic performance characteristics of NDL currently are undefined. METHODS. NDL was performed in 108 patients unselected for breast carcinoma risk and then was repeated after 2-14 months (median, 8 months) if the initial lavage was classified as atypical. Breast magnetic resonance images (MRIs) were obtained from a subset of patients who had atypical lavage results. RESULTS. Marked atypia was diagnosed in 22% of 36 breasts with an incident carcinoma compared with 7% of 172 unaffected breasts (P = 0.01). After excluding breasts with an incident carcinoma, there were 32 patients (30%) with either mild or marked atypia. The lavage was repeated in 23 of these women, and the second lavage was classified as atypical in 48%. Neither marked atypia on the initial lavage nor a 5-year Gail risk ≥ 1.7% predicted atypia on repeat lavage, but there was a trend for improved reproducibility when the atypia initially was diagnosed in a fluid-producing duct. MRIs were abnormal in 13% of 24 breasts with an atypical lavage, and ductal carcinoma in situ was diagnosed subsequently in 1 breast. CONCLUSIONS. Atypia frequently is diagnosed by NDL, but the reproducibility of repeat lavage is low. Lavage atypia may be physiologic or artifactual rather than pathologic in many instances. Marked atypia occasionally may represent mammographically occult ductal carcinoma in situ.

Original languageEnglish (US)
Pages (from-to)1129-1136
Number of pages8
JournalCancer
Volume103
Issue number6
DOIs
StatePublished - Mar 15 2005

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Nipples
Therapeutic Irrigation
Breast
Carcinoma, Intraductal, Noninfiltrating
Magnetic Resonance Spectroscopy
Breast Neoplasms
Carcinoma

Keywords

  • Breast neoplasms
  • Epithelial cells
  • Nipples
  • Precancerous conditions

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Johnson-Maddux, A., Ashfaq, R., Cler, L., Naftalis, E., Leitch, A. M., Hoover, S., & Euhus, D. M. (2005). Reproducibility of cytologic atypia in repeat nipple duct lavage. Cancer, 103(6), 1129-1136. https://doi.org/10.1002/cncr.20884

Reproducibility of cytologic atypia in repeat nipple duct lavage. / Johnson-Maddux, April; Ashfaq, Raheela; Cler, Leslie; Naftalis, Elizabeth; Leitch, Ann Marilyn; Hoover, Susan; Euhus, David M.

In: Cancer, Vol. 103, No. 6, 15.03.2005, p. 1129-1136.

Research output: Contribution to journalArticle

Johnson-Maddux, A, Ashfaq, R, Cler, L, Naftalis, E, Leitch, AM, Hoover, S & Euhus, DM 2005, 'Reproducibility of cytologic atypia in repeat nipple duct lavage', Cancer, vol. 103, no. 6, pp. 1129-1136. https://doi.org/10.1002/cncr.20884
Johnson-Maddux A, Ashfaq R, Cler L, Naftalis E, Leitch AM, Hoover S et al. Reproducibility of cytologic atypia in repeat nipple duct lavage. Cancer. 2005 Mar 15;103(6):1129-1136. https://doi.org/10.1002/cncr.20884
Johnson-Maddux, April ; Ashfaq, Raheela ; Cler, Leslie ; Naftalis, Elizabeth ; Leitch, Ann Marilyn ; Hoover, Susan ; Euhus, David M. / Reproducibility of cytologic atypia in repeat nipple duct lavage. In: Cancer. 2005 ; Vol. 103, No. 6. pp. 1129-1136.
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abstract = "BACKGROUND. It is believed that atypical cells identified by nipple duct lavage (NDL) indicate an increased risk for breast carcinoma similar to atypical ductal hyperplasia diagnosed by tissue biopsy, but many basic performance characteristics of NDL currently are undefined. METHODS. NDL was performed in 108 patients unselected for breast carcinoma risk and then was repeated after 2-14 months (median, 8 months) if the initial lavage was classified as atypical. Breast magnetic resonance images (MRIs) were obtained from a subset of patients who had atypical lavage results. RESULTS. Marked atypia was diagnosed in 22{\%} of 36 breasts with an incident carcinoma compared with 7{\%} of 172 unaffected breasts (P = 0.01). After excluding breasts with an incident carcinoma, there were 32 patients (30{\%}) with either mild or marked atypia. The lavage was repeated in 23 of these women, and the second lavage was classified as atypical in 48{\%}. Neither marked atypia on the initial lavage nor a 5-year Gail risk ≥ 1.7{\%} predicted atypia on repeat lavage, but there was a trend for improved reproducibility when the atypia initially was diagnosed in a fluid-producing duct. MRIs were abnormal in 13{\%} of 24 breasts with an atypical lavage, and ductal carcinoma in situ was diagnosed subsequently in 1 breast. CONCLUSIONS. Atypia frequently is diagnosed by NDL, but the reproducibility of repeat lavage is low. Lavage atypia may be physiologic or artifactual rather than pathologic in many instances. Marked atypia occasionally may represent mammographically occult ductal carcinoma in situ.",
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AB - BACKGROUND. It is believed that atypical cells identified by nipple duct lavage (NDL) indicate an increased risk for breast carcinoma similar to atypical ductal hyperplasia diagnosed by tissue biopsy, but many basic performance characteristics of NDL currently are undefined. METHODS. NDL was performed in 108 patients unselected for breast carcinoma risk and then was repeated after 2-14 months (median, 8 months) if the initial lavage was classified as atypical. Breast magnetic resonance images (MRIs) were obtained from a subset of patients who had atypical lavage results. RESULTS. Marked atypia was diagnosed in 22% of 36 breasts with an incident carcinoma compared with 7% of 172 unaffected breasts (P = 0.01). After excluding breasts with an incident carcinoma, there were 32 patients (30%) with either mild or marked atypia. The lavage was repeated in 23 of these women, and the second lavage was classified as atypical in 48%. Neither marked atypia on the initial lavage nor a 5-year Gail risk ≥ 1.7% predicted atypia on repeat lavage, but there was a trend for improved reproducibility when the atypia initially was diagnosed in a fluid-producing duct. MRIs were abnormal in 13% of 24 breasts with an atypical lavage, and ductal carcinoma in situ was diagnosed subsequently in 1 breast. CONCLUSIONS. Atypia frequently is diagnosed by NDL, but the reproducibility of repeat lavage is low. Lavage atypia may be physiologic or artifactual rather than pathologic in many instances. Marked atypia occasionally may represent mammographically occult ductal carcinoma in situ.

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