Discharges and Secretions of the Nipple

This study examines cell turnover within the lobules of the "resting" human breast and correlates it to the stage of the menstrual cycle. The results are based on the morphological identification of both cell multiplication (mitosis) and cell deletion (apoptosis). It is found that these events undergo significant cyclical changes during the menstrual cycle, with raised levels towards the end of the cycle and during menses. However, in relation to a 28-day menstrual cycle, the position of the mitotic and apoptotic peaks, at Days 25 and 28 respectively, are significantly different. The high values are associated with an increase in the number of lobules showing a slight response rather than a large reaction within a few lobules. It appears that the "resting" breast tissue shows a general, rather than a focal reaction to a given hormonal environment. The possible role of oestrogen and progesterone as effectors of these changes is discussed. Our results show that the menstrual cycle influences cell turnover, though different factors may be affecting mitosis and apoptosis.

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. 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. 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. 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.