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Ductal Lavage and Ductoscopy

Frequently Asked Questions

Q: What is ductal lavage?
A: Ductal lavage is a minimally invasive method of way of collecting cells from inside the milk ducts to determine if any of the cells are abnormal. Research has shown that the presence of abnormal ductal cells signals an increased risk of developing breast cancer.

Q: What is a ductoscopy?
A: A ductoscopy is used to help surgeons determine precisely how much tissue to remove when excising a tumor from the breast. The ductoscope, about the size of a pencil tip, enables a physician to look through the nipple directly into the milk ducts, where most breast cancer develops. Large, clear video images of the ducts are projected onto a screen. Ductoscopy can detect lesions less than one-tenth of a millimeter in size. The system is not designed to replace mammography, but to provide an early detection option for women at risk.

Q: What information can be gained from having ductal lavage?
A: If ductal lavage determines that the cells collected from a high-risk patient are abnormal, that patient’s individual risk of breast cancer is further increased. When a woman is making difficult decisions about treatments that may be life-changing -- such as prophylactic mastectomy or using a chemoprevention agent such as Tamoxifen – every bit of information helps.

Q: How is ductal lavage performed?
A: The procedure involves “rinsing” the milk ducts with a small amount of saline solution, which is infused through the nipple using a thin tube. The fluid is then withdrawn through the tube, put in a collection vial and sent to the lab to determine if any of the withdrawn cells are abnormal. The procedure usually takes less than an hour and can be done in a physician’s office.

Q: Does it hurt?
A: A numbing cream is applied to the nipple and an anesthetic fluid is put inside the duct to minimize discomfort. When women were asked to rate the level of comfort in a recent clinical study, in which 0 = no pain and 100 = severe pain. The median rating was 24.

Q: Who would benefit most from ductal lavage?
A: Ductal lavage is intended for women who are already at increased risk for breast cancer. This includes women who:

  • Have had breast cancer in the past;
  • Have close relatives who have had breast cancer (mother, sister, daughter)
  • Have a 5-year Gail risk of 1.7 percent or greater
  • Have a previous history of breast atypia or LCIS
  • Have the BRCA 1 or BRCA 2 gene mutation

Q: Is ductal lavage an acceptable substitute for a mammogram?
A: Ductal lavage should be used only with standard breast cancer-detection methods such as mammography, clinical examinations and breast self-examination. It is not a replacement for your current methods of breast health examinations and screening.

Q: Is ductal lavage covered by insurance?
A: There are a growing number of insurance plans that cover ductal lavage, however not all plans offer coverage. It’s best to check with your carrier before making an appointment.

Q: Is ductal lavage being used for research?
A: A clinical study that evaluates cells collected through ductal lavage is available at NorthShore University HealthSystem within the next year. More detailed molecular information about cells collected from the ducts may enhance diagnosis and treatment.

For More Information

For more specific questions, contact the Breast Evaluation Center at 847.570.1700.