Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

Jiwa, Natasha; Gandhewar, Rishikesh; Chauhan, Hemali; Ashrafian, Hutan; Kumar, Swathica; Wright, C. A.; Takáts, Zoltán; Leff, Daniel

doi:10.1245/s10434-020-09313-9

Cited by 6 publications

(6 citation statements)

References 67 publications

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“…Ki-67 antigen, expressed by proliferating cells, is an established molecular marker for breast cancer [ 22 ]. Nipple aspiration fluid (NAF) cytology is considered as predictor for breast cancer [ 23 ], with a high diagnostic specificity (0.97), but a low sensitivity (0.64) which limits diagnostic accuracy [ 24 ]. As hormonal stimulation of the breast tissue plays a considerable role in breast carcinogenesis and for the length of the menstrual cycle (MC), the latter might be relevant for breast cancer risk [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of the Intake of Isoflavones on Risk Factors of Breast Cancer—A Systematic Review of Randomized Controlled Intervention Studies

2021

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Epidemiological studies suggest that high intake of soy isoflavones may protect against breast cancer, but causal relationships can only be established by experimental trials. Thus, we aimed to provide a systematic review of randomized controlled trials (RCTs) on the effect of an isoflavone intake on risk factors of breast cancer in healthy subjects. After a systematic literature search in PubMed, 18 different RCTs with pre- and/or postmenopausal women were included and investigated for details according to the PRISMA guideline. In these studies, isoflavones were provided by soy food or supplements in amounts between 36.5–235 mg/d for a period of 1–36 months. Breast density, estrogens including precursors, metabolites, estrogen response such as length of menstrual cycle, and markers of proliferation and inflammation were considered. However, in most studies, differences were not detectable between isoflavone and control/placebo treatment despite a good adherence to isoflavone treatment, irrespective of the kind of intervention, the dose of isoflavones used, and the duration of isoflavone treatment. However, the lack of significant changes in most studies does not prove the lack of effects as a sample size calculation was often missing. Taking into account the risk of bias and methodological limitations, there is little evidence that isoflavone treatment modulates risk factors of breast cancer in pre- and postmenopausal women. Future studies should calculate the sample size to detect possible effects and consider methodological details to improve the study quality.

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Section: Introductionmentioning

confidence: 99%

Effect of the Intake of Isoflavones on Risk Factors of Breast Cancer—A Systematic Review of Randomized Controlled Intervention Studies

2021

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“…Pooled ultrasound sensitivity and specificity was 0.70 (range 0.60-0.80) and 0.58 (95% CI: 0.24-0.91); mammography sensitivity and specificity was 0.38 (95% CI: 0.23-0.52) and 0.79 (95% CI: 0.69-0.90); and MRI sensitivity and specificity was 0.70 (95% CI: 0.61-0.70) and 0.45 (95% CI: 0.20-0.70). 2 The key implication of this report is that nipple discharge fluid cytology is limited by low sensitivity, which is similar to all stand-alone diagnostic modalities.…”

Section: Presentmentioning

confidence: 86%

ASO Authors Reflection: Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature

Jiwa

Leff

2021

Ann Surg Oncol

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“…We attempted to identify NAF cell types per NAF class using fluorescence-activated cell sorting (FACS). However, this was hampered by sample viscosity, the sparse volume and the presence or very limited numbers of cells in the NAF samples, a finding also reported by others [63,[69][70][71][72][73][74][75]. Single cell sequencing, a technique that allows analyzing samples with a small number of cells, may help to decompose the cellular composition of NAF per color class, but this technique still needs to be tested in this context.…”

Section: Discussionmentioning

confidence: 99%

The changing microRNA landscape by color and cloudiness: a cautionary tale for nipple aspirate fluid biomarker analysis

et al. 2021

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Purpose Investigation of nipple aspirate fluid (NAF)-based microRNAs (miRNAs) as a potential screening tool for women at increased risk of developing breast cancer is the scope of our research. While aiming to identify discriminating NAF-miRNAs between women with different mammographic densities, we were confronted with an unexpected confounder: NAF sample appearance. Here we report and alert for the impact of NAF color and cloudiness on miRNA assessment. Methods Seven classes of NAF colors coupled with cloudiness appearance were established. Using 173 NAF samples from 154 healthy women (19 samples were bilaterally collected), the expression of 14 target and 2 candidate endogenous control (EC) miRNAs was investigated using Taqman Advanced miRNA assays to identify significant differential expression patterns between color-cloudiness classes. Inter- and intra-individual variation of miRNA expression was analyzed using the coefficient of variation (CV). Results We found that between the seven NAF classes, fold change miRNA expression differences ranged between 2.4 and 19.6 depending on the interrogated miRNA. Clear NAF samples exhibited higher miRNA expression levels compared to cloudy NAF samples with fold change differences ranging between 1.1 and 6.2. Inter-individual and intra-individual miRNA expression was fairly stable (CV < 15 %), but nevertheless impacted by NAF sample appearance. Within NAF classes, inter-individual variation was largest for green samples (CV 6-15 %) and smallest for bloody samples (CV 2-6 %). Conclusions Our data indicate that NAF color and cloudiness influence miRNA expression and should, therefore, be systematically registered using an objective color classification system. Given that sample appearance is an inherent feature of NAF, these variables should be statistically controlled for in multivariate data analyses. This cautionary note and recommendations could be of value beyond the field of NAF-miRNAs, given that variability in sample color and cloudiness is likewise observed in liquid biopsies such as urine, cerebrospinal fluid and sputum, and could thereby influence the levels of miRNAs and other biomarkers.

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Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

Cited by 6 publications

References 67 publications

Effect of the Intake of Isoflavones on Risk Factors of Breast Cancer—A Systematic Review of Randomized Controlled Intervention Studies

Effect of the Intake of Isoflavones on Risk Factors of Breast Cancer—A Systematic Review of Randomized Controlled Intervention Studies

ASO Authors Reflection: Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature

The changing microRNA landscape by color and cloudiness: a cautionary tale for nipple aspirate fluid biomarker analysis

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