Multiple sampling for increasing the diagnostic sensitivity of nipple aspirate fluid for atypical cytology

Acta Cytol. 2004 Nov-Dec;48(6):813-7. doi: 10.1159/000326451.

Abstract

Objective: To determine if repeated collection of nipple aspirate fluid (NAF) can improve the diagnostic sensitivity for cytologic atypia, a marker of increased risk of breast cancer.

Study design: Two hundred sixty-seven women without known breast disease volunteered for NAF cytology at 5 6-month intervals over 2 years. NAF samples were prepared on Millipore filters (Millipore Filter Corp., Bedford, Massachusetts, U.S.A.) and stained with a modified Papanicolaou method. Fluid availability and cellular abnormalities were evaluated for each collection attempt. Cellular findings were classified as benign, hyperplasia or atypia.

Results: NAF was obtained from 178 women (66.6%) at the first visit and from an additional 15, 10, 2 and 4 women at visits 2, 3, 4 and 5, respectively, for a cumulative total of 78.2% by visit 5. The number of women yielding NAF containing hyperplastic or atypical epithelial cells was determined at each visit. Hyperplastic cells were found in 34 (19.1%) at visit 1 and in an additional 20, 10, 5 and 4 women at visits 2, 3, 4 and 5, respectively. Atypical epithelial cells were present in 12 (6.7%) women at the initial visit and in an additional 11, 7, 5 and 1 women at visits 2, 3, 4 and 5, respectively, for a cumulative percent of 18.2 at visit 5. NAF could not be obtained from 58 women at any visit.

Conclusion: These findings suggest that an optimum collection method for NAF cytology should consist of at least 3 or 4 separate fluid aspiration attempts. Reviewing repeated multiple samples instead of 1 increases the number of women who can be evaluated and the likelihood of detecting cytologic atypia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Biopsy, Needle / methods
  • Biopsy, Needle / standards*
  • Breast Neoplasms / pathology*
  • Carcinoma / pathology*
  • Diagnostic Errors / prevention & control*
  • Epithelial Cells / pathology
  • Female
  • Humans
  • Hyperplasia / pathology
  • Mammary Glands, Human / metabolism
  • Mammary Glands, Human / pathology
  • Metaplasia / pathology
  • Middle Aged
  • Nipples / metabolism
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensitivity and Specificity