Ductal Lavage is a new procedure that has been approved for use as an adjunct to mammography for screening women at high risk for breast cancer. Most cancers arise in the cells lining the milk ducts (called the ductal epithelium). The first noticeable changes associated with cancer are changes in the way these ductal epithelial look; first they become mildly abnormal (mild atypia), then more abnormal looking (moderate atypia), until finally they become cancer cells (severe atypia/ malignant cells). Ductal Lavage allows us to collect ductal epithelial cells so that we can study how they look (their morphology) under the microscope and identify women who have abnormal cells. This procedure may allow us to detect cancers in women long before the cancer becomes visible on mammogram.
Just prior to the ductal lavage procedure, local anesthesia cream is applied to the nipple area to numb it. At the time of the procedure, the nipple is washed, and the breast is massaged to bring out fluid. An aspirator (a small suction cup, like a breast pump) is placed over the nipple and gentle suction is applied for a few minutes. This will bring up any fluid to help to find the openings of the milk ducts. Another way to identify the duct openings is to inject blue dye, combined with local anesthetic, into the nipple. The dye then tracks up the duct to stain the opening on the nipple surface. Once the milk duct opening is found, a tiny catheter, or tube (half the size of a needle for drawing blood), is inserted about ˝ inch into the duct. Local anesthesia is given to numb the inside of the duct. The duct is then gently washed out with a small amount of warm salt water. The breast is compressed and massaged to help bring out the cells and fluid. The cells in the fluid from your milk ducts are then studied under the microscope by a specially trained pathologist in order to determine whether any abnormalities are visible.
If severe atypia is found, further evaluation with imaging tests or surgical biopsy may be indicated. Mild to moderate atypia may be an indication for treatment with drugs that help to prevent the development of cancer (chemoprevention).
Ductal Lavage Links
