Congress Abstracts 2004

97

DUCTAL LAVAGE AND THE ADVANCE PRACTICE NURSE. Meghan Brennan, RN, MSN, ONP, and Anne Easthope, RN, MSN, NP, Cytyc Health Corporation, Boxborough, MA.

Advanced practice nurses (APNs) utilizing ductal lavage (DL) to facilitate risk assessment (RA) and risk reduction (RR) counseling.

Studies demonstrated a 5-fold increase in breast cancer when nuclear atypia is identified in breast duct cells. Additionally, risk increases 10-fold when family history is present with atypia. Previous cellular collection methods (aspiration and needle aspiration) were complicated by low cell yields or invasive approaches. DL, recommended for high-risk women, is a minimally invasive, well-tolerated technique with superior cellular yields. DL is performed in an office setting by trained clinicians, including physicians, physician assistants, and NPs. Because counseling high-risk women regarding risk reduction therapy is a challenge to many APNs, a method providing more insight to a patient’s current breast health can aid in risk reduction discussion. In addition DL offers a myriad of research opportunities related to breast cancer and prevention.

Prior to DL, topical anesthesia is applied to the nipple, the nipple is de-keratinized, and breast compression performed to maximize fluid toward the nipple. Subsequently, aspiration is performed to elicit nipple aspirate fluid identifying ducts for lavage. DL is done on nipple aspirate fluid-producing ducts based on a higher risk of breast cancer development in women with nipple aspirate fluid. A microcatheter is inserted into the duct, 10–20 cc of saline infused in 2–3 cc increments and removed by suction and breast compression. Samples are prepared in a cellular preservative and sent to a cytology lab for analysis. Results from DL are available usually within one week. Patients are explained the results and impact on their health.

Based upon a published study of 507 women at high risk who underwent DL, the majority will have benign (54%) results while a small percentage (24%) will have atypical results. Although the benign results may not lower a woman’s risk for developing breast cancer, based upon historic data, atypical results do increase her risk.

Since many APNs provide risk assessment and counseling to women, DL is a helpful adjunct to understanding a patient’s risk and helping her make important decisions regarding risk reduction strategies.