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Ductal Lavage of Fluid-Yielding and Non–Fluid-Yielding Ducts in BRCA1 and BRCA2 Mutation Carriers and Other Women at High Inherited Breast Cancer Risk

Division of Oncology, Departments of ¹ Medicine, ² Radiology, and ³ Pathology, Stanford University School of Medicine, Stanford, California; ⁴ Department of Medical Oncology, Dana-Farber Cancer Institute; and ⁵ Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Requests for reprints: Allison W. Kurian, Division of Oncology, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305-5820. Phone: 650-736-7252; Fax: 650-498-5150. E-mail: akurian{at}stanford.edu

Objective: Nipple fluid production and atypical breast duct cells in women at high risk of breast cancer have been associated with further increased risk. Most publications on ductal lavage for cell collection report cannulating fluid-yielding ducts only. We report lavage of fluid-yielding and non–fluid-yielding ducts in women at high inherited breast cancer risk.

Methods: A pilot breast cancer screening study including ductal lavage was conducted in 75 women at high inherited risk, 56 (74.7%) of whom had BRCA1/2 mutations. Ductal lavage was attempted in any duct identifiable with a catheter.

Results: Ducts were successfully catheterized in 60 of 75 patients (80%). Successfully catheterized patients were younger (median age 41 versus 53 years, P = 0.0003) and more often premenopausal (51.7% versus 20%, P = 0.041). Thirty-one successfully catheterized patients [51.6%, 95% confidence interval (39.4-63.9%)] had non–fluid-yielding ducts only. Seventeen patients [28.3% (18.5-40.9%)] had atypical cells. Twelve of seventeen [70.6% (46.8-87.2%)] samples with atypia were from non–fluid-yielding ducts. Patients with non–fluid-yielding ducts (versus fluid-yielding ducts) were more likely to have had prior cancer (48.4% versus 17.2%, P = 0.014) or chemotherapy (45.2% versus 17.2%, P = 0.027); this was also true in patients with atypia from non–fluid-yielding ducts.

Conclusion: Successfully lavaged women were younger and more often premenopausal. Atypical cells can be found in non–fluid-yielding ducts in patients at high inherited breast cancer risk. Non–fluid-yielding ducts, and atypia from non–fluid-yielding ducts, are more common in patients with prior cancer and chemotherapy. Larger studies are needed to identify risk factors and prognostic significance associated with atypia and non–fluid-yielding ducts in high-risk populations, and define their role as biomarkers.

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