Subcutaneous nipple sparing mastectomies (NSM) are an important tool in modern oncoplastic surgery. Especially when an immediate implant‐based reconstruction (IBR) is desired, clean margins are of the utmost importance. Central nipple biopsies during surgery serve two main purposes. Most importantly, it is hypothesized that intraoperative pathological evaluation of this biopsy may increase clean margin resection rates. In addition, a general recurrence risk reduction may occur due to the elimination of glandular and ductal components within the nipple. This analysis is a single center, multi‐surgeon, retrospective, head to head analysis. Starting in March 2015, intraoperative central nipple biopsy in NSMs with IBR was introduced at the Municipal Breast Cancer Centre Cologne, Holweide, Germany. This trial retrospectively evaluates global complication rates, clean margin status and local recurrence rates for cohort 1 (NSM/no nipple biopsy, n = 103) vs. cohort 2 (NSM with nipple biopsy, n = 108) Median follow‐up was 15 months. All implant‐based reconstruction procedures used an epipectoral implant pocket. Cohorts were comparable. Global complication rates slightly favored the nipple biopsy cohort with respects to implant loss rate. An involved central nipple biopsy was found in 4.6% (n = 5/108) of the performed NSM procedures leading to the immediate removal of the nipple areola complex. All positive retro‐areolar biopsies correlated with a positive nipple biopsy. However, in n = 1 case we found DCIS discontinual proliferation with an involved nipple biopsy, without a correlating positive retro‐areolar biopsy (ie, 1 false‐negative case was prevented). For the 15 month follow‐up, there was no case of local recurrence within nipple areola complex for both cohorts. With this retrospective head to head analysis of 211 patients, it was shown that the central nipple biopsy correlates well with the retro‐areolar biopsy. There may be a reduction in false negative rates. The procedure is safe to use and should be offered to NSM patients.
Background: Subcutaneous nipple sparing mastectomies (NSM) are an important tool in modern oncoplastic surgery. Especially when an immediate implant-based reconstruction (IBR) is desired, clean margins are of the utmost importance. Central nipple biopsies during surgery serve two main purposes. Most importantly, it is hypothesized that a general recurrence risk reduction occurs due to elimination of glandular and ductal components within the nipple. In addition, intraoperative pathological evaluation of this biopsy may increase clean margin resection rates. This trial aimed to evaluate complication rates, local recurrence and clean margin resection rates in a head-to-head retrospective manner. Methods: Starting in 2015, intraoperative central nipple biopsy in NSM with IBR was introduced at the Municipal Breast Cancer Centre Cologne, Holweide, Germany. This trial evaluates global complication rates (necrosis, implant loss, seroma and hematoma), long term local recurrence and clean margin status for cohort 1 (n=100) SSM with nipple biopsy vs. cohort 2 (control, n = 100) without nipple biopsy. In case of an involved central nipple biopsy, the nipple areola complex was removed. This analysis is a single center, multi-surgeon, retrospective, head to head analysis. Median follow-up is three years. All IBR procedures used an epipectoral implant pocket. Results: Global complication rates did not differ significantly between both cohorts. There was no increased rate of implant loss and or revision surgery. Within the medium three-year follow-up there was no case of local recurrence within nipple areola complex for both cohorts. An Involved central nipple biopsy was however found in 2% (n=2 /100) of the performed SSM procedures leading to the immediate removal of the nipple areola complex. Surgical time did not increase with central biopsy. A significantly higher rate of re-surgery due to involved margins was shown in the control cohort. Conclusions: This analysis showed that intraoperative evaluation of the ductal components of the nipple is a safe procedure. At least 2% of the patients showed an immediate advantage of this procedure since clean margins were obtained by removing the nipple areola complex during the same surgery. The medium follow-up showed no significant difference in local recurrence. We therefore strongly, recommend a central nipple biopsy for all NSM procedures. Citation Format: Eichler C, Stephan S, Thangarajah F, Puppe J, Mathias W. Intraoperative central nipple biopsy in subcutaneous mastectomies - A retrospective analysis of 200 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-11.
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