Does ductal lavage assert its role as a noninvasive diagnostic modality to identify women at low risk of breast cancer development?

Objective

Ductal lavage (DL) involves evaluation of the ductal system of the breast for detection of intra-ductal carcinomas and precursor lesions by collecting breast epithelial cells using a small-gauge catheter inserted into a ductal orifice on the nipple. The aim of this survey was to analyze cytologic features of samples obtained from low-risk women with DL and to elucidate the efficacy of this diagnostic modality in evaluating fluid production, cannulating and determining atypical breast epithelial cells.

Methods

Into this prospective study were consecutively registered 80 women between ages 28 to 67. Nipple aspiration was performed to identify all fluid-yielding ducts. According to the grading of specific features the interpretation of the sample included: normal/benign (category, 0), mild atypical (category, I), markedly atypical (category, II) or malignant (category, III) disorders.

Results

Ninety five percent (316/334) of the nipple aspirate fluid samples were classified as category 0, 4.8% (16/334) as category I and 0.2% (2/334) as category II changes. Category III disorders were not detected. Therefore, in 80% of the women examined results were within normal limits while 17.5% of the participants presented mild atypical and 2.5% markedly atypical rates.

Conclusion

DL collection procedure proved to be rapid as well as acceptable by the women studied. It retains the advantage over other methods of nipple aspirate fluid in that it is easy to perform, thereby removing most clinician variability. It also helped low risk women to discriminate those with breast disorders that require additional investigation, further follow-up or administration of preventive medication.

Facing the challenge of treating gallbladder carcinoma. Review of the literature

Gallbladder carcinoma (GBC) remains the most common biliary tract malignancy and is characterized as an aggressive and highly lethal disease. There is also a wide discrepancy among sources regarding the epidemiology of the tumor. Despite recent research on the therapeutic strategies against gallbladder neoplastic disorders, surgical resection appears the only potentially curative approach. Unfortunately, a mere minority of patients is eligible to undergo surgical intervention. In addition, surgical removal of gallbladder tumor does not necessarily guarantee patient's long-term recovery. Alternative therapies, such as radio and chemotherapy proved insufficient. The aim of this review was to evaluate the results of surgical treatment for GBC with special reference to the extent of its histological spread and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease.