Evaluation of the Role of Duct Endoscopy in the Assessment of Cellular Atypia Within Breast Duct Fluid in High-Risk Women Carrying BRCA1/2 or p53 Gene Mutations
- Correlate cell yield and morphology findings from ductal lavage with duct endoscopy
findings and any subsequent surgical pathology findings in high-risk women with BRCA1,
BRCA2, or p53 gene mutations who have cellular atypia.
- Determine the prevalence of occult breast cancer in patients with cellular atypia
undergoing duct endoscopy.
- Determine patient acceptance of duct endoscopy.
- Perform immunohistochemical analysis (including estrogen receptor, progesterone
receptor, HER2-neu receptor, epidermal growth factor receptor, p53, and proliferation
marker expression) for markers potentially associated with breast cancer in these
- Determine potential molecular markers of malignancy by gene methylation, gene
expression, and proteomics in these patients.
OUTLINE: Patients undergo nipple aspiration to identify productive ducts and collect fluid
for tumor marker assessment followed by ductal lavage over 15 minutes. Patients undergo duct
endoscopy over approximately 30 minutes under local anesthesia. If no abnormality is found,
duct endoscopy is repeated in 6 months. If the repeat duct endoscopy is normal, patients
continue to undergo nipple aspiration or ductal lavage as specified in protocols RMNHS-2242
and RMNHS-2269. If an abnormality is found during either the initial or repeat duct
endoscopy, patients may undergo further assessment comprising imaging or biopsy and/or
appropriate surgical intervention.
Fluid is analyzed for tumor markers by immunohistochemistry. Candidate genes are analyzed by
gene methylation studies, gene expression arrays, and proteomic analysis.
Patients are followed for at least 5 years.
PROJECTED ACCRUAL: A total of 45-60 patients will be accrued for this study within 2 years.
Primary Purpose: Diagnostic
Comparison of cell yields and morphology from ductal lavage vs the ductal anatomy visualized at duct endoscopy
Gerald Gui, MD, MS, FRCS(Edin), FRCS(Eng)
Royal Marsden NHS Foundation Trust