Lancet 1996 Oct 12;348(9033):997-9 Related Articles, Books, LinkOut


Breast-duct endoscopy to study stages of cancerous breast disease.

Love SM, Barsky SH

Department of Surgery, University of California, Los Angeles, USA.

BACKGROUND: In breast-cancer research, we lack reproducible non-invasive
access to breast tissue. Breast cancer is thought to start in the lining of
the milk duct or lobule. We have had no direct access to this area other
than in tissue removed surgically or by fine-needle aspiration. Our
objective was to explore an intraductal approach to studying breast cancer
and precancerous changes by duct cannulation and endoscopy. METHODS: In this
pilot study, women in a university hospital were asked to participate. Nine
patients with previously diagnosed ductal carcinoma-in-situ (DCIS) or
invasive breast cancer who were about to undergo mastectomy under general
anaesthesia agreed. After the patient was asleep but before the operation,
we spent 15 minutes cannulating their ducts, obtaining washings, and
attempting endoscopy. The ducts that had been cannulated were marked by
instillation of dye or other materials, the nipple was sutured shut, and the
mastectomy proceeded as planned. The mastectomy specimen underwent extensive
histopathological examination. FINDINGS: We were successful in intraductal
cannulation and endoscopy in seven of the nine patients. In five of the
nine, we obtained epithelial cells in the washings. In one the cells were
consistent with proliferative disease, in three there was atypical
epithelium, and in one there was frank DCIS. With several different contrast
materials injected into separate duct orifices, DCIS was confined to a
single duct system. INTERPRETATION: We found that the intraductal approach
is feasible for the study of the early changes of breast cancer Technical
difficulties include identification of the breast duct orifices, determining
the distensibility of the duct, and developing a reliable technique to
obtain washings.

PMID: 8855857, UI: 97008740

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