Ductal lavage not a sensitive screening tool for breast cancer, study suggests.(News)

The sensitivity of ductal lavage in detecting breast cancer was so low in a recent study that it cannot be recommended as a screening tool, investigators have reported.

"Ductal lavage should not be recommended to high-risk women as a technique to detect cancer earlier than imaging modalities," said Seema A. Khan, M.D., of Northwestern Memorial Hospital in Chicago, and associates.

The findings put a damper on interest generated several years ago when William Dooley, M.D., and his colleagues found severely atypical cells in ductal lavage specimens from 11 women without any evidence of malignancy and then identified cancers in 4 of these women by biopsy.

The new study looked at the association between ductal lavage cytologic findings and histologic findings in women undergoing mastectomy primarily for known cancer.

Investigators found poor agreement between cytologic and histologic findings and a sensitivity of ductal lavage of only 13%-42%, depending on how a positive result was defined.

"If we can find a good molecular screen to improve its sensitivity, then ductal lavage may still be good for [detecting] small cancers ... but right now it's clear that cytology is a pretty insensitive thing," Dr. Dooley, director of the Breast Health Institute at the University of Oklahoma in Oklahoma City, said in an interview. Dr. Dooley was not an investigator in the new study.

In ductal lavage--a technique designed to improve the cell yield of nipple fluid aspiration--fluid-yielding ducts are cannulated and flushed with a physiologic solution, and the resultant effluent is examined for epithelial cells and cytomorphology.