Ductal lavage of non-fluid yielding ducts in BRCA1 and BRCA2 mutation carriers and other women at high genetic risk for breast cancer

Abstract

9535 Background: Atypical breast duct cells in patients at increased risk of breast cancer have been predictive of subsequent breast cancer. It has been reported that women whose breasts yield no fluid on nipple suction aspiration have lower risk for breast cancer than women whose breasts yield fluid; publications on ductal lavage (DL) have reported attempt of DL only on patients with fluid-yielding ducts (FY) on initial suction aspiration. We report preliminary results of a study of DL including evaluation of non-fluid yielding ducts (NFY) in women at increased genetic risk of breast cancer. Methods: A pilot study of screening with breast MRI, mammogram, and ductal lavage was conducted in 41 women at increased genetic risk of breast cancer; 26 (63%) had BRCA mutations, and 15 (37%) were included because family history conveyed greater than 10% breast cancer risk at 10 years via the Claus model. Whether or not fluid was obtained on suction aspiration, ducts which could be identified with a dilator underwent attempted lavage. Cytologic diagnostic categories were benign, atypical, or malignant. Fisher's exact test, 2 tailed, was used for statistical analysis. Results: DL was successful in 34 of 41 patients (82.9%); 17 (50%) had NFY. Ten patients (29.4%) had atypical cells; none had malignant cells. Seven of 17 patients (41.2%, 95% confidence interval 18.4–67.1%) with NFY had atypical cells. Patients with atypical cells from NFY were more likely than those with atypical cells from FY to have a BRCA mutation (57.1 versus 0%, p 0.20). Patients with NFY were more likely than those with FY to have had breast or ovarian cancer (58.8% versus 17.6%, p 0.03), and to have received chemotherapy (47.1% versus 17.6%, p 0.14). Conclusions: Atypical cells can be found in NFY patients at high risk for breast cancer, with trends toward higher incidence of atypical cells from NFY in BRCA mutation carriers, and of NFY in cancer survivors. Larger studies are needed to confirm this finding, and to identify risk factors and outcomes associated with atypical cells and NFY. No significant financial relationships to disclose.