Ductal hyperplasia, along with familial factors and reproductive history, is featured in several breast cancer-predictive algorithms including the Gail and Tyrer-Cuzick models conferring a twofold to fourfold risk increase for benign and atypical hyperplasia, respectively. However, absent of prior biopsy, information on ductal pathology is usually absent, possibly leading to underestimation of breast cancer risk with consequent failure to identify many women who could benefit from preventive strategies. We explored if nipple aspirate fluid collection for cytology, complimentary to breast examination and history, is feasible in the general obstetrics and gynecology practice.
Bilateral nipple aspirate fluid specimens were collected with the ForeCYTE Breast Aspirator. Stained per Pap, specimens were placed directly under the microscope, avoiding washing with consequent cell loss. Cytology was graded per the King classification.
Fifty-two women age 21–65 years were enrolled in a single practice; three operators collected 104 nipple aspirate fluid specimens; 97% of collections yielded nipple aspirate fluid as evidenced by basophilic staining, adequate for microscopic interpretation; 98 were graded King class I (normal), five class II (ductal hyperplasia without atypia), and one class III (atypical hyperplasia). The latter finding, confirmed by a second pathologist, concerned a 23-year-old woman's right breast with the left breast normal. There were no adverse events and no nipple aspirate fluid collection was interrupted or aborted because of discomfort.
Nipple aspirate fluid collection for cytologic analysis is feasible in a general practice, well tolerated by patients, and may provide an actionable complement to other methods in the identification of women at increased risk for development of breast cancer.