The advantages of using nipple fluid aspiration as a screening tool for early detection of breast cancer are that it's safe, simple to perform, well tolerated, inexpensive, noninvasive, and radiation free, investigators said at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

There is a real need for an adjunct or alternative to mammography in high-risk women, especially prior to age 50, when mammography's sensitivity is reduced because of greater breast density, the researchers noted.

Nipple aspirate fluid analysis was first described by Dr. George Papanicolaou in the mid-1950s as "the breast Pap test."

Large prospective studies starting in the 1970s, with more than a decade of follow-up, showed that the presence of atypical ductal cells in women with a family history of breast cancer was associated with a 30% increased risk of subsequent breast cancer.

But the technique was plagued by poor collection rates and didn't catch on. In Dr. Papanicolaou's first study, for example, he had a success rate of only 18% in aspirating nipple fluid, noted Dawanda Pesicka of the University of California, Los Angeles.

With improved technique, multiple investigators have more recently shown that the yield can be boosted to greater than 80%, and to 95% in premenopausal women. Still, there is a definite learning curve, she stressed.

Ms. Pesicka reported on 153 women who underwent nipple aspirate fluid collection by a single examiner over a 1-year period. Even using standardized collection procedures, there was an obvious learning curve extending out to about the first 60 patients. Before that point, the aspiration yield was only 40%; after, it rose to consistently in excess of 80%. There was a 15% rate of cellular atypia in this patient series, with two malignancies detected.

In a separate presentation, Dr. Gillian Mitchell explained that nipple aspiration fluid bathes the ductal epithelial cells, which are what undergo malignant transformation in breast cancer. The aspirate contains exfoliated ductal epithelial cells as well as a variety of biochemical substances secreted by the cells.

Some of the substances in nipple aspirate fluid, including prostate-specific antigen, may prove to be workable markers of early breast cancer.

In the early days of nipple fluid aspiration, women were simply asked to lie naked and flat on an examination table in a cold room. Little wonder, then, that when the suction device was slapped onto their breast, the success rate in obtaining fluid was unacceptably low; Dr. Mitchell noted.

The major improvement in technique has involved a recognition that a woman must be properly prepared for the procedure. Nowadays she is first helped to relax. The breast is warmed with heating' pads and stimulated via self-manual massage before and during the collection procedure. She sits upright while leaning slightly forward, said Dr. Mitchell of the Institute of Cancer Research, Sutton, England.

Ms. Pesicka added that a key technical aspect of breast ductal fluid aspiration involves dekeratinizing the nipple with a rough gauze and either alcohol or Cerumenex 3%.

By systematically varying the aspiration technique every 30 patients in her series, she found that neither heating pads nor having women lean forward were important in boosting yields.

The key elements in increasing yields appeared to be self-massage before and during the procedure, as well as dekeratinizing the nipple, she said.

Her study was funded by Pro Duct Health, a Palo Alto, Calif.-based manufacturer of a nipple aspiration device.

Return to Cerumenex

Home

Contact

Resources

Exchange Links

ebay