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Prostate-Specific Antigen Levels in Nipple Aspirate Fluid

Thomas Jefferson University, Philadelphia, PA
Mt Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

To the Editor:We reviewed with interest the article by Zhao et al.¹ The authors collected nipple aspirate fluid (NAF) from women with recently diagnosed cancer, those with atypia or in situ carcinoma, and those without breast lesions. They were successful in collecting NAF from 34% of subjects and had adequate NAF to perform analyses in 29.6% of subjects who consented to undergo aspiration. The authors observed similar levels of prostate-specific antigen (PSA) in tumor-free breasts and in those recently diagnosed with breast cancer. The authors speculate that the differences observed in our original study² were a result of hemodilution in the NAF collected from mastectomy specimens, which, in turn, resulted in lower PSA levels.

We have obtained NAF from 97% of the last 500 women who consented to undergo the procedure. We divided the NAF specimen equally, half for cytologic review and half for other biomarker studies. One of the aspects of cytologic review is to evaluate the specimen for red cells. We recently evaluated specimens from 110 women with breast cancer. Thirty-two specimens (29%) were observed to contain red blood cells. There was no statistically significant difference in NAF PSA levels in specimens with and without blood whether considering the population as a whole or grouped by menopausal status. When we eliminated specimens containing blood and compared PSA levels in women with and without breast cancer, controlling for menopausal status and age, we found that PSA was significantly lower in NAF from the breasts with cancer than from the breasts without cancer (P = .0001).

We are not sure why the results of the two studies differ, but we do not believe it is because of hemodilution. One difference was the fraction of women from whom a sample was obtained. The authors do not indicate the fraction of subjects from whom NAF was collected in the tumor-free versus tumor-containing breasts. Because NAF was obtained from only one third of the subjects consenting to undergo the procedure, the population studied may not reflect the population as a whole.

Many of our NAF specimens from women with breast cancer have come from mastectomy specimens. We perform aspiration immediately after the breast is removed from the chest wall. In the article by Zhao et al,¹ NAF was performed in women after they had been diagnosed with breast cancer but before definitive therapy had been instituted. We elected to forego aspiration on women with proven breast cancer before mastectomy both because the breast is often painful after diagnostic needle biopsy and because of the subject’s heightened anxiety. Fortunately, the weaknesses of both approaches are being addressed by us and by other groups prospectively performing nipple aspiration in women scheduled to undergo surgery for a suspicious lesion without a definitive diagnosis. These studies have a number of benefits. They minimize potential bias due to a diagnosis of breast cancer. Also, because the subject has not undergone a fine- or core-needle biopsy that leaves her breast tender, often too tender to undergo nipple aspiration, one is more likely to obtain NAF. These studies should help determine the usefulness of PSA levels in breast aspirate fluid in predicting the chance that a subject has or will develop breast cancer.

REFERENCES

1. Zhao Y, Verselis SJ, Klar N, et al: Nipple fluid carcinoembryonic antigen and prostate-specific antigen in cancer-bearing and tumor-free breasts. J Clin Oncol 19: 1462-1467, 2001[Abstract/Free Full Text]

2. Sauter ER, Daly M, Linahan K, et al: Cancer Epidemiol Biomarkers Prev 5:967-970, 1996

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sauter, E. R. Articles by Diamandis, E. P. Search for Related Content PubMed PubMed Citation Articles by Sauter, E. R. Articles by Diamandis, E. P. Social Bookmarking                            What's this?