Patterns of reduced nipple aspirate fluid production and ductal lavage cellularity in women at high risk for breast cancer.
Patterns of reduced nipple aspirate fluid production and ductal lavage cellularity in women at high risk for breast cancer.
复制标题
DOI：
10.1186/bcr1335
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
King BL
中科院分区：
文献类型：
--
作者：
Higgins SA;Matloff ET;Rimm DL;Dziura J;Haffty BG;King BL
乳头抽吸是一种非侵入性技术，用于从乳头导管开口获取乳腺液体，以评估与乳腺癌相关的异常。48%至94%的健康女性可产生乳头吸液，其产生与乳腺癌发病的相对风险增加有关。NAF的产生已在研究中用于指导导管灌洗的导管选择，这是一种将导管插管并用生理盐水冲洗以收集细胞的程序。在之前一项评估导管内入路治疗乳腺癌高危女性的多中心试验中，在84%的受试者中观察到NAF的产生。然而，我们观察到，在类似的高风险女性中，流质产生的比例明显较低。本研究的目的是确定与这种减少有关的变量。对33名高风险妇女（定义为5年Gail模型指数大于1.7，有乳腺癌个人或家族史，和/或BRCA1或BRCA2种系突变）进行乳头抽吸，以确定导管孔是否适合洗胃手术。对所有产液导管和9个不产液导管进行灌洗。在本系列研究中，33名受试者中有12名（36%）发现了产液导管，而在我们的多中心试验中，19名受试者中有16名（84%）发现了产液导管（P = 0.001）。NAF的减少与绝经后状态（P = 0.02）、BRCA种系突变（P = 0.004）和降低风险的治疗相关，包括双侧输卵管卵巢切除术（BSO）和/或选择性雌激素受体调节剂（SERMs, P = 0.009）。9例（100%）非产液导管灌洗标本均为脱细胞，而产液导管标本13例（3例）为脱细胞（P < 0.001）。与先前的多中心试验相比，本系列对高危妇女的分析揭示了NAF产生和导管灌洗细胞减少的模式。本系列包括更多的brca阳性妇女，其中许多人接受了BSO和/或正在使用serm。我们的数据表明，与这些降低风险的疗法相关的内分泌机制可能与乳腺液体产生减少的模式有关。
Nipple aspiration is a noninvasive technique for obtaining breast fluids from the duct openings of the nipple for the evaluation of abnormalities associated with breast cancer. Nipple aspirate fluid (NAF) can be elicited from 48 to 94% of healthy women, and its production has been linked to an increased relative risk for breast cancer development. NAF production has been used in studies to guide the selection of ducts for ductal lavage, a procedure in which ducts are cannulated and flushed with saline to collect cells. In a previous multicenter trial to evaluate intraductal approaches in women at high-risk for breast cancer, NAF production was observed in 84% of the subjects. However, we observed a significantly lower proportion of fluid-yielding subjects in a similar series of high-risk women. The purpose of the present study was to identify variables associated with this reduction. Nipple aspiration was performed on 33 high-risk women (defined as having a 5-year Gail model index of more than 1.7, a personal or family history of breast cancer, and/or a BRCA1 or BRCA2 germline mutation) to identify ductal orifices for lavage procedures. Lavage was performed on all fluid-yielding ducts and on nine non-fluid-yielding ducts. Fluid-yielding ducts were identified in 12 of 33 (36%) of the subjects in the present series, compared with 16 of 19 (84%) of the subjects undergoing identical procedures at our facility during a multicenter trial (P = 0.001). Reduced NAF yields were associated with postmenopausal status (P = 0.02), BRCA germline mutations (P = 0.004), and risk reduction therapies, including bilateral salpingo-oophorectomy (BSO) and/or selective estrogen receptor modulators (SERMs; P = 0.009). All nine (100%) of the ductal lavage specimens collected from non-fluidyielding ducts were acellular, in comparison with 3 of 13 specimens from fluid-yielding ducts (P < .001). Analysis of high-risk women in the present series revealed patterns of reduced NAF production and ductal lavage cellularity compared with a previous multicenter trial. The present series included more BRCA-positive women, many of whom had undergone BSO and/or were using SERMs. Our data suggest that endocrine mechanisms associated with these risk-reducing therapies may be related to patterns of diminished breast fluid production.