Ductal lavage
Ductal lavage is a minimally invasive procedure aimed at detecting changes in breast cells that may signify precancerous or cancerous conditions. Often referred to as the "breast Pap smear," this technique traces its origins to the theories proposed by Dr. George Papanicolaou in the 1950s, who suggested that nipple fluid could be analyzed for signs of cancer. The procedure focuses primarily on identifying ductal carcinoma in situ (DCIS), as a significant percentage of breast cancers begin in the milk ducts.
Typically performed on women at high risk for breast cancer or those with a history of the disease, ductal lavage is not intended as a screening tool and should not replace mammography. The process involves applying a numbing cream to the nipple, followed by gentle breast massage to facilitate fluid movement. A suction device collects fluid from the milk ducts, which is then rinsed with saline to wash out cells for microscopic analysis.
While the procedure is generally well-tolerated, risks such as duct injury and infection, though rare, can occur. Results indicating normal cell presence suggest no abnormalities, although atypical changes may be detected without clear implications for cancer risk. As of the mid-2020s, ductal lavage's role has diminished in favor of ductoscopy, another method that allows for direct collection of cells from the milk ducts.
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Ductal lavage
DEFINITION: Ductal lavage is a minimally invasive method used to detect gradual changes in breast cells that could indicate a precancerous or cancerous condition. It has been dubbed the “breast Pap smear.” The idea dates back to the 1950s, when Dr. George Papanicolaou (1883–1962), the inventor of the Pap smear to detect cervical cancer, first theorized that nipple fluid could be analyzed for precancerous changes.
Cancers diagnosed:Ductal carcinoma in situ (DCIS)
Why performed: According to Johns Hopkins Medicine, 15 to 20 percent of new breast cancers originate as masses in the milk ducts. Invasive ductal carcinoma accounts for 70 to 80 percent of breast cancer cases. Ductal lavage can identify atypical or abnormal changes in breast cells that may fuel cancer development in the future. The test is used to assess women at high risk of breast cancer. It is also used to evaluate women who previously had breast cancer. It is not intended as a screening tool for breast cancer, nor is it a replacement for mammography.
Patient preparation: No preparation is needed.
Steps of the procedure: A numbing cream is applied to the nipple area. The woman is asked to massage the breast area gently with both hands to help move fluid toward the nipple. A suction device placed over the nipple siphons tiny amounts of fluid from the milk ducts, which helps detect the natural duct openings. Once they are identified, a slender, hollow tube called a is inserted into each duct that produced fluid. Saline flows through the catheter, rinsing out the duct and washing out cells. (Lavage is a French word that means “wash” or “rinse.”) The fluid containing the cells is then analyzed under a microscope. Ductal lavage can be performed on an outpatient basis.
After the procedure: The procedure does not usually cause any discomfort. Some women may have a temporary feeling of pressure, tingling, or fullness afterward. No special follow-up care is needed.
Risks: The risks of ductal lavage are rare, but they may include damage to a milk duct and infection at the site of the catheter insertion. Signs of infection include breast redness, warmth, severe tenderness, and persistent fever.
Results: A normal result means that no abnormal cells were detected. In some cases, analysis of the milk duct cells may reveal atypical changes but cannot pinpoint their exact origin in the breast. Not every woman with atypical breast cell changes will develop breast cancer. Experts recommend that the procedure be done along with a clinical breast examination and an imaging study, such as mammography. Further, ductal lavage was being evaluated for effectiveness in the mid-2020s and had largely been replaced by ductoscopy, another minimally invasive procedure that allowed doctors to collect cells from milk ducts.
Bibliography
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