The role of ductal lavage in the management of women at high risk for breast carcinoma.

Ductal lavage (DL) is a recently introduced technique for nonsurgical breast epithelial sampling of asymptomatic high-risk women. It is based on exfoliative cytology of duct epithelial cells, obtained by cannulation and lavage of ducts that produce nipple fluid after breast massage and nipple aspiration. DL provides information similar to that obtained by cytologic examination of nipple aspiration fluid and random periareolar fine needle aspiration. Women who demonstrate cytologic atypia on these tests can be assumed to be at higher risk for breast cancer and may benefit from prophylactic medication. DL promises to provide more reproducible sampling of the same area of the breast, as opposed to methods of random sampling, such as random fine needle aspiration, but the degree of reproducibility remains to be demonstrated. If reproducibility is greater than with random periareolar fine needle aspiration, DL may represent an important advance in the design of phase II chemoprevention trials, particularly because it also provides another source of material for judging response to prevention agents (ie, the protein component of nipple aspiration fluid), which can be analyzed for levels of hormones, specific proteins, and protein profiles obtained with proteomics. Early data do not suggest that DL is an effective screening tool for breast cancer on the basis of cytologic interpretation of DL samples, although this may change if effective molecular markers are validated for cancer detection in women at high risk.