The intraductal approach to the breast: raison d'être

Abstract

Opportunities for the detection, prediction, and treatment of breast cancer exist at three biological levels: systemically via the blood, at the whole organ level, and within the individual ductal lobular structures of the breast. This review covers the evaluation of approaches targeted to the ductal lobular units, where breast cancer begins. Studies to date suggest the presence of 5 to 12 independent ductal lobular systems per breast, each harboring complex cellular fluids contributed by local and systemic processes. New techniques for accessing and interrogating these systems offer the potential to gauge the microenvironment of the breast and distill biological risk profiles.

Figure 1

Ductal systems of the breast. (a) Ductal systems as depicted by Astley Cooper (1841). (b) Computer reconstruction of ductal systems as depicted by James Going and colleagues (2004; copyright the Pathological Society of Great Britain and Ireland; reproduced with permission granted by John Wiley and Sons Ltd on behalf of the PathSoc). (c) 'Tubercles' as depicted by Astley Cooper (1841). (d) 'Tubercle' as depicted by Otto Sartorius (1972).

Figure 2

Drops of nipple aspirate fluid from four duct openings display varied coloration, suggesting that the ductal systems of the breast are anatomically distinct, and that some breast fluid properties exhibit interductal variation.

Figure 3

Fluorescence in situ hybridization (FISH) analysis of a ductal lavage specimen collected from a patient with invasive breast cancer and classified as cytologically benign reveals a rare cluster of cells exhibiting chromosomal aneusomy [39].