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Sauter ER , Klein-Szanto A , MacGibbon B , Ehya H
Nipple Aspirate Fluid and Ductoscopy to Detect Breast Cancer
Diagnostic Cytopathology. 2010 Apr;38(4) :244-251
PMID: ISI:000276114700003   
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Abstract
We prospectively performed cytologic assessment and image analysis (IA) on matched nipple aspirate fluid (NAP) and mammary ductoscopy (MD) specimens to determine (1) the accuracy of these methods in cancer detection and (2) whether the two collection methods provide complementary information. NAF and MD specimens were collected from 84 breasts from 75 women (nine bilateral samples) who underwent breast surgery. Cytologic evaluation was performed on all samples. IA was performed on slides with sufficient epithelial cells. Cytologic evaluation proved more accurate in patients without pathologic spontaneous nipple discharge (PND) than those with PND, mainly because of the potential false positive diagnosis in the latter. While the sensitivity of NAF and MD cytology was low (10% and 14%, respectively), both were 100% specific in cancer detection in the non-PND cohort. Combining NAP and MD cytology information improved sensitivity (24%) without sacrificing specificity. Similar to cytology. IA was more accurate in patients without PND having high specificity (100% for aneuploid IA), but relatively low sensitivity (36%). Combining NAP and MD cytology with aneuploid IA improved the sensitivity (45%) while maintaining high specificity (100%). The best predictive model was positive NAF cytology and/or MD cytology combined with IA aneuploidy, which resulted in 55% sensitivity and 100% specificity in breast cancer detection. Cytologic evaluation and IA of NAF and MD specimens are complementary. The presence of atypical cells arising from an intraductal papilloma in ductoscopic specimens is a potential source of false positive diagnosis in patients with nipple discharge. Diagn. Cytopathol. 2010;38:244-251. (C) 2009 Wiley-Liss, Inc.
Notes
Sauter, Edward R. Klein-Szanto, Andres MacGibbon, Brenda Ehya, Hormoz NIH [CA-87391]; Natural Sciences and Engineering Research Council of Canada [RGPIN92037] Contract grant sponsor: NIH; Contract grant number: CA-87391; Contract grant sponsor: Natural Sciences and Engineering Research Council of Canada; Contract grant number: RGPIN92037. 21 Wiley-liss; div john wiley & sons inc, 111 river st, hoboken, nj 07030 usa 576aa