HORMONAL CHARACTERIZATION AND CLASSIFICATION OF BREAST CYST FLUID IN GROSS CYSTIC MASTOPATHY

Gross cystic disease (GCD) of the breast may be associated with a high er risk for the development of breast cancer. High levels of sex stero ids, steroid hormone precursors, prolactin and cations have been found in breast cyst fluid (BCF) by several investigators. Accordingly, end ocrine parameters and the cationic composition of BCF may be considere d as useful characteristics to follow patients bearing macrocysts. In this study we have investigated the concentrations of estradiol (E(2)) , progesterone, testosterone, dehydroepiandrosterone (DHA) and DHA-3-s ulfate (DHA-S), prolactin, potassium (K+) and sodium (Na+) in BCF aspi rated from 99 women. The mean age of the patients was 49.8 years (rang e 32-58). The hormone levels were measured by RIA methods; K+ and Nawere determined by flame photometry. Estradiol, progesterone, testoste rone, DHA, DHA-S, prolactin and K+ showed significant accumulation in the BCF compared with their respective serum values. The K+/Na+ ratio proved to be useful in dividing cysts into type I(greater than or equa l to 1), type II (<1 but greater than or equal to 0.1) and type III (< 0.1) subgroups. For type I BCE higher DHA, DHA-S and prolactin concent rations were detected. Linear regression analysis established a highly significant (P<0.001) correlation between the concentrations of E(2) and DHA-S (r=0.686), and also between testosterone and DHA-S (r=0.711) . These findings indicate that type I BCF might be a marker for 'activ e' GCD of the breast, and suggest that it may be associated with an in creased breast cancer risk, since this group of patients is supposed t o have cysts with apocrine metaplasia. It is suggested therefore that when BCF is aspirated, sex steroids, steroid precursors and cations sh ould be routinely measured, and women with type I cysts should be regu larly examined.