Reproducibility of cytologic atypia in repeat nipple duct lavage
Reproducibility of cytologic atypia in repeat nipple duct lavage
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DOI：
10.1002/cncr.20884
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发表时间：
2005-03-15
期刊：
影响因子：
6.2
通讯作者：
Euhus, DM
中科院分区：
文献类型：
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作者：
Johnson-Maddux, A;Ashfaq, R;Euhus, DM
背景据认为，乳头导管灌洗（NDL）鉴定的非典型细胞提示乳腺癌的风险增加，类似于组织活检诊断的非典型导管增生，但NDL的许多基本性能特征目前尚不明确。对108例有乳腺癌风险的患者进行了NDL，如果首次灌洗被归类为非典型，则在2-14个月（中位数，8个月）后重复NDL。乳腺磁共振成像（MRI）是从一个亚组的患者谁有不典型的灌洗结果。在36例乳腺癌患者中，22%的患者被诊断为明显的乳腺癌，而在172例未受影响的乳腺中，这一比例为7%（P = 0.01）。排除乳腺癌后，有32例（30%）患者有轻度或明显的乳腺癌。其中23名妇女重复灌洗，48%的第二次灌洗被归类为非典型。无论是首次灌洗时的显著尿失禁，还是5年Gail风险大于或等于1.7%，都不能预测重复灌洗时的尿失禁，但当尿失禁最初诊断为产液导管时，有提高再现性的趋势。在24例非典型灌洗的乳腺中，13%的乳腺MRI异常，1例乳腺随后被诊断为导管原位癌。异型性常通过NDL诊断，但重复灌洗的重复性低。在许多情况下，灌洗性腹泻可能是生理性的或人为的，而不是病理性的。乳腺钼靶X线检查中，明显的乳腺癌有时可能是隐性导管原位癌。
BACKGROUND. It is believed that atypical cells identified by nipple duct lavage (NDL) indicate an increased risk for breast carcinoma similar to atypical ductal hyperplasia diagnosed by tissue biopsy, but many basic performance characteristics of NDL currently are undefined.METHODS. NDL was performed in 108 patients unselected for breast carcinoma risk and then was repeated after 2-14 months (median, 8 months) if the initial lavage was classified as atypical. Breast magnetic resonance images (MRIs) were obtained from a subset of patients who had atypical lavage results.RESULTS. Marked atypia was diagnosed in 22% of 36 breasts with an incident carcinoma compared with 7% of 172 unaffected breasts (P = 0.01). After excluding breasts with an incident carcinoma, there were 32 patients (30%) with either mild or marked atypia. The lavage was repeated in 23 of these women, and the second lavage was classified as atypical in 48%. Neither marked atypia on the initial lavage nor a 5-year Gail risk greater than or equal to 1.7% predicted atypia on repeat lavage, but there was a trend for improved reproducibility when the atypia initially was diagnosed in a fluid-producing duct. MRIs were abnormal in 13% of 24 breasts with an atypical lavage, and ductal carcinoma in situ was diagnosed subsequently in 1 breast.CONCLUSIONS. Atypia frequently is diagnosed by NDL, but the reproducibility of repeat lavage is low. Lavage atypia may be physiologic or artifactual rather than pathologic in many instances. Marked atypia occasionally may represent mammographically occult ductal carcinoma in situ.