BREAST CYTOPATHOLOGY

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162 6. Breast Ductal Lavagecarcinoma in situ (ductal or lobular type) were identified insix cases, and ducts or lobules in tissue sections also containingcarcinoma in situ were found in seven. These findingsdemonstrate that DL had sampled a duct involved by carcinomain situ or an area of the breast spatially close to carcinomain about 80% of cases. Nonetheless, DL has lowsensitivity for the detection of carcinoma, and a benign samplecannot exclude malignancy. Khan et al. have obtained similarresults and noted that the location of carcinoma in situ inrelation to the nipple may affect the ability to detect atypicalcells in the DL fluid. In both studies, the results of DL in thecancer-affected breast may have been limited due to possibledistortion of the ducts caused by invasive carcinoma in somecases.Lobular carcinoma in situ, an alteration of the mammaryepithelium associated with high risk of breast carcinoma,was the only morphologic alteration in three mastectomyspecimens in one correlative study. Two of the correspondingDL samples showed mild atypia with morphologic featurescompatible with lobular carcinoma in situ. Injected bluedye identified a duct and a few lobules involved by lobularcarcinoma in situ in one case. This is, to date, the onlydocumented example of DL sampling lobular carcinomain situ.Because of some limitations in the cytologic interpretationof DL samples, future evaluation of this type of sample maycombine cytology with other techniques, such as methylationspecificpolymerase chain reaction, analysis of loss of heterozygosity,chromosome copy number determination, and/orproteomic analysis.Studies are in progress to investigate the clinicalsignificance of the new methodologies summarized inthis chapter. “Intraductal” investigation of mammary carcinomaand its precursor lesions can provide insight intothe biology of this disease and its clinical management.Cytology has had a determinant role in the developmentof this novel approach and will most certainly continueto play a critical role in their future development andapplication.
Selected Reading 163Selected ReadingBrogi E, Miller MJ, Casadio C, Ljung B-M, Montgomery L:Paired ductal lavage and fine needle aspiration specimens frompatients with breast carcinoma. Diagn Cytopathol 2005, 33:370–375.Brogi E, Robson M, Panageas KS, Casadio C, Ljung BM, MontgomeryL: Ductal lavage in patients undergoing mastectomy formammary carcinoma: a correlative study. Cancer 2003, 98:2170–2176.Dooley WC, Ljung BM, Veronesi U, Cazzaniga M, Elledge RM,O’Shaughnessy JA, Kuerer HM, Hung DT, Khan SA, Phillips RF,Ganz PA, Euhus DM, Esserman LJ, Haffty BG, King BL,Kelley MC, Anderson MM, Schmit PJ, Clark RR, Kass FC,Anderson BO, Troyan SL, Arias RD, Quiring JN, Love SM, PageDL, King EB: Ductal lavage for detection of cellular atypia inwomen at high risk for breast cancer. J Natl Cancer Inst 2001,93:1624–1632.Johnson-Maddux A, Ashfaq R, Cler L, Naftalis E, Leitch AM,Hoover S, Euhus DM: Reproducibility of cytologic atypia inrepeat nipple duct lavage. Cancer 2005, 103:1129–1136.Khan SA, Wiley EL, Rodriguez N, Baird C, Ramakrishnan R, NayarR, Bryk M, Bethke KB, Staradub VL, Wolfman J, Rademaker A,Ljung BM, Morrow M: Ductal lavage findings in women withknown breast cancer undergoing mastectomy. J Natl Cancer Inst2004, 96:1510–1517.King EB, Barrett D, King MC, Petrakis NL: Cellular compositionof the nipple aspirate specimen of breast fluid. I. The benign cells.Am J Clin Pathol 1975, 64:728–738.King EB, Barrett D, Petrakis NL: Cellular composition of the nippleaspirate specimen of breast fluid. II. Abnormal findings. AmJ Clin Pathol 1975, 64:739–748.King EB, Chew KL, Petrakis NL, Ernster VL: Nipple aspirate cytologyfor the study of breast cancer precursors. J Natl Cancer Inst1983, 71:1115–1121.King BL, Crisi GM, Tsai SC, Haffty BG, Phillips RF, Rimm DL:Immunocytochemical analysis of breast cells obtained by ductallavage. Cancer 2002, 96:244–249.Krassenstein R, Sauter E, Dulaimi E, Battagli C, Ehya H,Klein-Szanto A, Cairns P: Detection of breast cancer in nippleaspirate fluid by CpG island hypermethylation. Clin Cancer Res2004, 10:28–32.
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Breast Cytopathology
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Syed Z. Ali, MDDepartment of Pathol
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To my parentsGul Bano (late) and Ma
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viiiForewordthis volume to rejuvena
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xSeries Prefaceand form the framewo
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xiiPrefacecarefully selected high-r
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ContentsForeword by Dorothy L. Rose
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2 1. Introduction and Technical Asp
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10 1. Introduction and Technical As
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2Non-neoplastic andProliferative Le
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Figure 2.26. Lactational change. Hy
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58 3. Benign and Borderline TumorsC
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60 3. Benign and Borderline TumorsF
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68 3. Benign and Borderline Tumors
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84 3. Benign and Borderline TumorsG
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86 4. Primary Malignant Tumors• M
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88 4. Primary Malignant TumorsFigur
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92 4. Primary Malignant TumorsHisto
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100 4. Primary Malignant TumorsFigu
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Page 152 and 153: 5Metastatic and SecondaryTumorsMeta
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Page 168 and 169: 154 6. Breast Ductal LavageTable 6.
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Page 180 and 181: 166 IndexApocrine carcinomain axill
Page 182 and 183: 168 IndexDuctal carcinoma (cont.)fi
Page 184 and 185: 170 IndexFine-needle aspiration, of
Page 186 and 187: 172 IndexLung cancer, 138metastatic
Page 188 and 189: 174 IndexPapilloma (cont.)invasive
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BREAST CYTOPATHOLOGY

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