Clinical Question: Is ductal lavage effective in detecting breast cancer?

Setting: Inpatient (any location)

Study Design: Cross-sectional

Synopsis: In this study, 32 women (mean age: 50 years) undergoing prophylactic (n = eight) or therapeutic (n = 35) mastectomy received ductal lavage in the operating room before surgery. The women were enrolled consecutively. To confirm that ducts were lavaged successfully, the surgeon injected a colored dye for the pathologist to identify. The authors do not report whether the cytologists and pathologists were blinded to other test results.

This study emphasized the analysis of 42 breasts. Two of the women undergoing prophylactic mastectomy had occult malignancies. At least one duct was lavaged successfully in 36 breasts, but only 31 yielded adequate cellular fluid. Cytology detected cancer in only five cancerous breasts. The ability of ductal lavage to find cancer in a breast is limited. Lavage detected marked atypia only 42 percent of the time and was accurate only one half of the time. Lowering the threshold so that mild atypia also was defined as abnormal decreased the overall accuracy and detected only 20 percent of the cancers. Because this was an extremely high-risk population, the sensitivity, even among high-risk women, would be even lower.

Bottom Line: In this small study, ductal lavage was insensitive for detecting breast cancer. (Level of Evidence: 2b)