BlueCross BlueShield of Tennessee Medical Policy Manual

Cytologic Evaluation in Breast Cancer Risk Assessment


The analysis of epithelial cells from breast duct fluid is intended as a tool to assess an individual's risk for breast cancer. A variety of techniques exist to obtain epithelial cells for cytologic evaluation, including random periareolar fine needle aspiration, nipple aspirate fluid, ductal lavage and suction.

Most breast cancers develop from the epithelial cells that line the breast ducts. Because abnormalities in these tissues may indicate an elevated risk of developing breast cancer, histologic examination of these tissues has been proposed as an aid in detecting individuals who are at risk of developing the disease. However, the clinical utility of these tests (e.g. FirstCyte™ Breast Test, HALO Nipple Aspirate Fluid collection system) are still being evaluated.




There is insufficient evidence to evaluate the impact on net health outcome, therefore these procedures remain investigational.


American College of Obstetricians and Gynecologists. (2017, September)  ACOG Practice bulletin #182: hereditary breast and ovarian cancer syndrome. Retrieved July 24, 2018 from

Danforth, D., Warner, A., Wangsa, D., Ried, T., Duelli, D., Filie, A., & Prindiville, S. (2015). An improved breast epithelial sampling method for molecular profiling and biomarker analysis in women at risk for breast cancer. Breast Cancer, 2015 Jun 8: 9, 31-40. (Level 4 evidence)

National Comprehensive Cancer Network. (1.2017). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast cancer screening and diagnosis v 2.2018. Retrieved July 24, 2018 from




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