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Ductal Lavage Findings in Women With Mammographic Microcalcifications Undergoing Biopsy

¹ Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine of Northwestern University, 675 North St. Clair Street, Galter 13-174, Chicago, Illinois 60614
² Department of Radiology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60614
³ Department of Pathology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60614

Correspondence: Address correspondence and reprint requests to: Seema A. Khan, MD; E-mail: skhan{at}nmh.org

Background: We designed a prospective study to assess the likelihood that early lesions presenting as mammographic calcifications could be accessed for cytological diagnosis by ductal lavage (DL).

Methods: Consenting women with calcifications (Breast Imaging Reporting and Data System 4 or 5) underwent DL of fluid-yielding ducts (FYDs) before stereotactic core or excisional biopsy. The DL catheter was used to inject .2 to 1 mL of Isovue 300 into the duct to determine whether the FYD corresponded to the duct containing calcifications (designated overlap). Additional FYDs were injected, if possible, until overlap was identified. DL cytology was compared with histology.

Results: Twenty women were enrolled (mean age, 54.2 years); the mean size of the calcification-bearing area was 190 mm². The histological findings were as follows: 1 invasive cancer, 9 ductal carcinomas-in-situ (DCIS), 5 atypical hyperplasias, and 5 usual hyperplasias or fibrocystic changes. Four women had no FYD. In 15 women who underwent DL and ductography, overlap of dye and calcifications was seen in 4 (27%): 1 fibrocystic change, 1 hyperplasia, 1 atypical hyperplasia (cytological diagnosis mildly atypical), and 1 DCIS (cytological diagnosis benign). Of the remaining 8 DCIS lesions, 4 had no nipple aspiration fluid, 1 showed extravasation, and 3 were lavaged but the duct did not overlap.

Conclusions: These results are consistent with data from women undergoing mastectomy for larger invasive cancer and DCIS and show that cancer-containing ducts do not yield nipple fluid in most cases.

Key Words: Breast cancer • Detection • Ductal lavage • Microcalcifications • Cytology