Ductal lavage for detection of cellular atypia in women at high risk for breast cancer.

BACKGROUND: Breast cancer originates in breast epithelium and is associated with progressive molecular and morphologic changes. Women with atypical breast ductal epithelial cells have an increased relative risk of breast cancer. In this study, ductal lavage, a new procedure for collecting ductal cells with a microcatheter, was compared with nipple aspiration with regard to safety, tolerability, and the ability to detect abnormal breast epithelial cells. METHODS: Women at high risk for breast cancer who had nonsuspicious mammograms and clinical breast examinations underwent nipple aspiration followed by lavage of fluid-yielding ducts. All statistical tests were two-sided. RESULTS: The 507 women enrolled included 291 (57%) with a history of breast cancer and 199 (39%) with a 5-year Gail risk for breast cancer of 1.7% or more. Nipple aspirate fluid (NAF) samples were evaluated cytologically for 417 women, and ductal lavage samples were evaluated for 383 women. Adequate samples for diagnosis were collected from 111 (27%) and 299 (78%) women, respectively. A median of 13,500 epithelial cells per duct (range, 43-492,000 cells) was collected by ductal lavage compared with a median of 120 epithelial cells per breast (range, 10-74,300) collected by nipple aspiration. For ductal lavage, 92 (24%) subjects had abnormal cells that were mildly (17%) or markedly (6%) atypical or malignant (<1%). For NAF, corresponding percentages were 6%, 3%, and fewer than 1%. Ductal lavage detected abnormal intraductal breast cells 3.2 times more often than nipple aspiration (79 versus 25 breasts; McNemar's test, P<.001). No serious procedure-related adverse events were reported. CONCLUSIONS: Large numbers of ductal cells can be collected by ductal lavage to detect atypical cellular changes within the breast. Ductal lavage is a safe and well-tolerated procedure and is a more sensitive method of detecting cellular atypia than nipple aspiration.

The influence of aspirin on gastrointestinal microbleeding in dogs with gastric ulcers.

Fecal blood volume was determined daily in 11 dogs with single gastric ulcers. Beginning 11 days after production of the ulcers and dogs received, in crossover fashion, 2 placebo or ordinary 325-mg aspirin tablets orally twice daily during two 7-day treatment periods separated and followed by 5-day periods of no treatment. Mean daily fecal blood volumes of 0.52 and 3.25 ml were observed during periods of treatment with placebo and aspirin, respectively. However, in 7 previous studies in this laboratory a total of 24 normal dogs have received 7-day courses of treatment with 650 mg ordinary aspirin twice daily on 105 occasions; during these 105 treatment periods fecal blood volume averaged 2.90 ml/day. Thus, it is concluded that the effect of ordinary aspirin in dogs with gastric ulcers is essentially the same as the effect in normal dogs, and that there is no tendency for dogs with gastric ulcers to bleed massively in response to aspirin.