Loud Jennifer T, Thiébaut Anne C M, Abati Andrea D, Filie Armando C, Nichols Kathryn, Danforth David, Giusti Ruthann, Prindiville Sheila A, Greene Mark H
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD 20852, USA.
Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1243-51. doi: 10.1158/1055-9965.EPI-08-0795. Epub 2009 Mar 31.
Ductal lavage has been used for risk stratification and biomarker development and to identify intermediate endpoints for risk-reducing intervention trials. Little is known about patient characteristics associated with obtaining nipple aspirate fluid (NAF) and adequate cell counts (> or =10 cells) in ductal lavage specimens from BRCA mutation carriers.
We evaluated patient characteristics associated with obtaining NAF and adequate cell counts in ductal lavage specimens from the largest cohort of women from BRCA families yet studied (BRCA1/2 = 146, mutation-negative = 23, untested = 2). Fisher's exact test was used to evaluate categorical variables; Wilcoxon nonparametric test was used to evaluate continuous variables associated with NAF or ductal lavage cell count adequacy. Logistic regression was used to identify independent correlates of NAF and ductal lavage cell count adequacy.
From 171 women, 45 (26%) women had NAF and 70 (41%) women had ductal lavage samples with > or =10 cells. Postmenopausal women with intact ovaries compared with premenopausal women [odds ratio (OR), 4.8; P = 0.03] and women without a prior breast cancer history (OR, 5.2; P = 0.04) had an increased likelihood of yielding NAF. Having breast-fed (OR, 3.4; P = 0.001), the presence of NAF before ductal lavage (OR, 3.2; P = 0.003), and being premenopausal (OR, 3.0; P = 0.003) increased the likelihood of ductal lavage cell count adequacy. In known BRCA1/2 mutation carriers, only breast-feeding (OR, 2.5; P = 0.01) and the presence of NAF (OR, 3.0; P = 0.01) were independent correlates of ductal lavage cell count adequacy.
Ductal lavage is unlikely to be useful in breast cancer screening among BRCA1/2 mutation carriers because the procedure fails to yield adequate specimens sufficient for reliable cytologic diagnosis or to support translational research activities.
导管灌洗已用于风险分层、生物标志物开发以及确定降低风险干预试验的中间终点。对于与从携带BRCA突变的女性中获取乳头抽吸液（NAF）以及导管灌洗标本中获得足够细胞计数（≥10个细胞）相关的患者特征，人们了解甚少。
我们评估了来自迄今为止研究的最大BRCA家族女性队列（BRCA1/2 = 146，突变阴性 = 23，未检测 = 2）的导管灌洗标本中与获取NAF和足够细胞计数相关的患者特征。采用Fisher精确检验评估分类变量；采用Wilcoxon非参数检验评估与NAF或导管灌洗细胞计数充足性相关的连续变量。采用逻辑回归确定NAF和导管灌洗细胞计数充足性的独立相关因素。
在171名女性中，45名（26%）女性有NAF，70名（41%）女性的导管灌洗样本中有≥10个细胞。与绝经前女性相比，有完整卵巢的绝经后女性[比值比（OR），4.8；P = 0.03]以及无乳腺癌病史的女性（OR，5.2；P = 0.04）获取NAF的可能性增加。曾进行母乳喂养（OR，3.4；P = 0.001）、导管灌洗前存在NAF（OR，3.2；P = 0.003）以及处于绝经前状态（OR，3.0；P = 0.003）增加了导管灌洗细胞计数充足的可能性。在已知的BRCA1/2突变携带者中，只有母乳喂养（OR，2.5；P = 0.01）和存在NAF（OR，3.0；P = 0.01）是导管灌洗细胞计数充足的独立相关因素。
导管灌洗在BRCA1/2突变携带者的乳腺癌筛查中不太可能有用，因为该操作无法获得足够的标本用于可靠的细胞学诊断或支持转化研究活动。
