Expression Of Tumor Genes In The Exfoliative Cells Of Ductal Lavage And Their Relationship With Breast Carcinoma

Objectives: To evaluate the quality of exfoliative cytology of ductal lavage anddiagnostic value of exfoliative cytology of ductal lavage on breast carcinoma. Tobuild a method of immunocytochemical staining to detect the expression of Her2,c-Myc, p21, p27, p53 genes in exfoliative cells of ductal lavage. To study theexpression of Her2, c-Myc, p21, p27, p53 genes in the exfoliative cells and theirrelationship with breast carcinoma.Methods: 108 patients including 76 cases with nipple discharge and 32 cases withbreast lump were examined by ductoscopy. We scraped the minimal lesions ofbreast ducts with biopsy needle, lavaged the breast ducts by physiological saline,and collected fluids of ductal lavage to smear for Papanicolaou staining andimmunocytochemical staining to detect the expression of Her2, c-Myc, p21, p27,p53 genes. 76 patients with nipple discharge were performed exfoliative cytologybefore ductoscopy examination. 40 tissue specimens excised from 12 cases ofintraductal papilloma and 28 cases of ductal carcinoma were studied byimmunohistochemistry to evaluate the immunocytochemistry of exfoliative cells.Results: (1) The cell content of smears was estimated by ranking classification. 76smears of nipple discharge and 108 smears of ductal fluids were classified, grade"-"in 50 cases and 20 cases, grade "+"in 15 cases and 40 cases, grade "++"in 9cases and 31 cases, grade "+++"in 2 cases and 17cases, separately. Adequatespecimens were collected by ductal lavage method as compared to theconventional squeezing method (P<0.01). (2) In the 36 cases of breast ductalbenign diseases, smears of nipple discharge revealed benign in 35 cases andsuspicious malignancy in 1 case, and smears of ductal fluids revealed benign in 33cases and suspicious malignancy in 3 cases. Statistics analysis showed nosignificant difference in diagnosis of breast ductal benign diseases by two kinds ofsmear method (P>0.05). In the 10 cases of breast carcinoma with nipple discharge,smears of nipple discharge diagnosed malignancy in 1 case, suspicious malignancyin 4 cases, benign in 5 cases. In the 42 cases of breast carcinoma, smears of ductalfluids diagnosed malignancy in 19 cases, suspicious malignancy in 12 cases,benign in 11 cases. Statistics analysis showed cytology method of ductal fluidsprovided much more accurate than the conventional squeezing method in diagnosisbreast carcinoma (P<0.05). (3) In the 42 cases of breast carcinoma, the positiverate of Her2, c-Myc, p21, p27, p53 protein in the exfoliative cells was23.81%(10/42), 7.14%(3/42), 16.67%(7/42), 9.52%(4/42) and 21.43%(9/42),separately. In the 46 cases of breast benign diseases, the positive rate of Her2,c-Myc, p21, p27, p53 protein in the exfoliative cells was 0.00%(0/46),0.00%(0/46), 2.17%(1/46), 0.00%(0/46) and 2.17%(1/46), separately. The positiverate of Her2, p21 and p53 proteins in exfoliative cells of breast carcinoma washigher than that of breast benign diseases, and expression of c-Myc and p27 geneswas no significant difference between the two groups (P<0.05). (4) The positiverate of Her2, p21, p53 protein in the breast tissues was 32.50%(13/40),30.00%(12/40) and 30.00%(12/40), separately. The result ofimmunohistochemistry was consistent with that of immunocytochemistry, andcorrelated coefficient was 0.8208, 0.7899 and 0.8537, separately (P<0.01).Conclusions: (1) The quantity of cell masses obtained through scraping theminimal lesions of breast ducts and ductal lavage is higher than that ofconventional squeezing method.(2)Using the method of dot smear to concentratecell masses, we can observe smears easily. Due to contrast cells of normalepithelium on the smears, we can identify malignant cells and benign cells easilyand diagnose breast cancer more accurately. (3) The positive expression of Her2,c-Myc, p21, p27, p53 genes in exfoliative cells is detected, furthermore detectingthe expression of Her2, p21, p53 genes in the exfoliative cells may contribute todistinguishing benign from malignant breast ductal diseases. (4) The Expression ofHer2, p21, p53 genes in breast...