A simple intraductal aspiration method for cytodiagnosis in nipple discharge

OBJECTIVE: To increase cytodiagnostic accuracy for women with spontaneous n ipple discharge using a simple intraductal aspiration method. STUDY DESIGN: We compared the cytodiagnostic accuracy of the conventional s queezing collection method and intraductal aspiration by intravenous cathet er in a total of 146 women with spontaneous nipple discharge in a single du ct without a mass; they had been pathologically identified at Kaohsiung Med ical University Hospital. RESULTS: Adequate specimens were collected in 96.6% (141/146 cases) of the sample by the intraductal aspiration method as compared to 76.0% collected by the conventional squeezing method (P <.05). An adequate specimen should consist, at a minimum, of six cohesive clusters of well-preserved epithelia l cells, with each cluster composed of at least five cells other than foam cells. The cytologic diagnosis was divided into five categories: positive i n 9 cases, suspicious in 10, negative with atypical findings in 59, negativ e in 33 and inadequate specimens in 35 cases that employed the squeezing me thod. These results were less satisfactory than with the intraductal aspira tion method: the smears were positive in 17 cases, suspicious in 14, negati ve with atypical finding in 78, negative in 32 and inadequate specimen in 5 . Our results showed it sensitivity of 92.3% and specificity of 93.9% for t he intraductal aspiration method as compared to a sensitivity of 52.9% and specificity of 89.3% for the squeezing method. Among the 27 cancers in this series, correct cytodiagnosis, including suspicious cases, was made in 24 cases by intraductal aspiration, with an accuracy of 88.9%, as compared to the 33.3% (9/27) accuracy of the squeezing method (P<.05). CONCLUSION: For patients with spontaneous nipple discharge, the intraductal aspiration method provides much more accurate cytodiagnosis than does the conventional squeezing method.