A novel nipple–areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients

Seki, Hirohito; Sakurai, Takashi; Mizuno, Shodai; Tokuda, Toshiki; Kaburagi, Takuji; Seki, Minako; Karahashi, Tsuyoshi; Nakajima, Kenichiro; Shimizu, Ken; Jinno, Hiromitsu

doi:10.1007/s12282-019-00987-y

Cited by 10 publications

(10 citation statements)

References 37 publications

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“…Each factor had a score of 0 or 1, and the total scores were used to categorize patients into low (0–3), intermediate (4), or high (5–7) risk groups. It was recommended that the nipple should be be sacrificed in patients in the high-risk group and that patients in the intermediate-risk group who hoped to preserve the nipple should be undergo frozen section examination ( 14 ). Another study by Wang et al proposed a model consisting of tumor location, nuclear grade, and HER2 expression ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

“…Published studies have revealed a low incidence of local cancer recurrence after NSM in selected patients ( 8 – 13 ). Nevertheless, the preservation of the nipple remains a matter of concern due to occult nipple involvement (NI) ( 14 ). Thus, it is critical to develop clinical models to accurately predict occult nipple involvement for carrying out NSM effectively and safely.…”

Section: Introductionmentioning

confidence: 99%

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A nomogram based on clinical factors for preoperative prediction of nipple involvement in breast cancer

Huang

Qiu

Mu³

et al. 2022

Front. Surg.

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BackgroundAt present, the indication for nipple-sparing mastectomy (NSM) remains inconclusive, and occult nipple involvement (NI) is one of the most important problems when carrying out NSM. Therefore, we aimed to identify the predictive factors of NI, to provide a tool for selecting suitable candidates for NSM.MethodsIn this retrospective study, a total of 250 breast cancer patients who received mastectomy were recruited, and the association between NI and tumor clinicopathologic characteristics was investigated. Nipple signs, tumor size measured by ultrasound (US), and tumor location were developed as a nomogram to predict NI.ResultsAmong the 250 patients, 34 (12.6%) had NI, and 216 (86.4%) did not. In the training group, NI was associated with nipple signs, tumor size, tumor–nipple distance (TND), tumor location, lymph node metastasis, and HER2 overexpression. Both in the training and in the validation groups, NI showed a significant association with nipple signs, tumor size measured by ultrasound, and tumor location. Based on these three clinical factors, the preoperative model nomogram was proved to have high efficiency in predicting NI, possessing a sensitivity of 80.0% and a specificity of 86.7% in the validation group.ConclusionsWe proposed a predictive model nomogram utilizing preoperative tumor characteristics, including nipple signs, tumor size measured by ultrasound, and tumor location. This predictive model could help in the planning of nipple-sparing mastectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A nomogram based on clinical factors for preoperative prediction of nipple involvement in breast cancer

Huang

Qiu

Mu³

et al. 2022

Front. Surg.

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“…As for the predictive model A recent study produced a preoperative predictive model using seven factors,including MRI tumor size≥4cm, mammographic TND 1cm,MRI TND 1cm MRI nipple enhancement,central tumor,multicentric/multifocal, clinical node involvement.Each factor scores 0 or 1 point,and the total scores were categorized into low (0-3), intermediate (4), or high (5-7) risk group.Patients in high risk group were recommended to sacri ce the NAC,and patients in the intermediate risk group who hoped to preserve NAC could undertake the frozen section examination [33].Besides,another study by Wang at al proposed a model consisting of tumor location, nuclear grade,and HER2 expression [28].Schecter at al reported a formula for predicting NAC involvement based on tumor size,TND and stage,which was found to have a sensitivity of 92%, speci city of 77% [34].The models developed in these studies are basing on more costly image testing or preoperative biopsy.The factors including pathological TND,tumor size,number of metastatic lymph node,HER2 overexpression were generally known after surgery.Whereas,parameters of the predictive model in our study are much more easier to obtain.Basing on ultrasound tumor size,tumor location,and nipple signs,a predictive model were proposed to provide the possibility of NAC involvement.We found breast cancer patients with abnormal nipple signs,in central location, and tumor size 4cm,were most likely to develope NAC involvement (95.4%);patients with normal nipple signs,tumor in peripheral location,and tumor size ≤4cm had a lowest possibility(4.1%) of NAC involvement.…”

Section: Discussionmentioning

confidence: 99%

The Associated Clinicopathologic Characteristics of Nipple-Areola Complex Involvement in Breast Cancer

Huang¹,

Huang²,

Jiang³

et al. 2021

Preprint

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Background. At present,the indication for nipple-sparing mastectomy（NSM）remains inconclusive,and the occult NAC involvement （NI）is one of the most considerable problem when carrying out NSM.We aimed at identifying the predictive factors of NAC involvement,to provide an implement of selecting suitable NSM candidates.Methods. The association between the NI and tumorous clinicopathologic characteristics of 272 mastectomies and 31 therapeutic NSM performed in our hospital from 2016 to 2018，were retrospectively evaluated.Results.38 of 272（14.0%）mastectomies and 2 of 31（6.5%）NSM were confirmed to have NAC involvement, and all the intraoperative frozen section examination of the sub-areolar/nipple tissue were consistent with the permanent section examination in NSM. The median follow-up durations for NSM was 24 months,local recurrence occurred in 1 of 30（3.2%） patients.Among 272 mastectomies，the NAC involvement showed significant association with the abnormal nipple signs（P＜0.001），tumor size ＞4cm measured by ultrasound （P＜0.001）and gross pathologic samples（P＜0.001），tumor-nipple distance ＜1cm（P=0.003），central location（P＜0.001），lymph node metastasis（P=0.004），and HER2 overexpression（P=0.023）.A preoperative predictive model of NAC involvement utilizing nipple signs(normal or abnormal),tumor size(≤4cm or ＞4cm),tumor location(central or peripheral) showed a PPV of 85.7% and a NPV of 90.3%.Conclusions.The local recurrence rate after NSM is low （3.2%）in our study，and the intraoperative frozen section examination plays an important role in the procedure of NSM.Further more，we proposed a predictive model of the NAC involvement utilizing the preoperative tumorous characteristics，including the nipple signs，tumor size measured by ultrasound，and the tumor location.This predictive model could be working in the planning of breast cancer surgery.

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“…Hirohito et al 16 also measured the TND, and considering other factors such as the tumor size, location (central versus peripheral), nipple enhancement by MRI, multicentric/multifocal cancer, and clinical node involvement created an index to help choose appropriate candidates for NSM. According to these criteria, NAC involvement rate was determined to be 3.5% in low-risk, 68.7% in intermediate-risk, and 90% in high-risk specimens.…”

Section: Discussionmentioning

confidence: 99%

Tumor-to-Nipple Distance in Selecting Patients for Nipple-sparing Mastectomy

Kracoff-Sella

Allweis

Bokov

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Introduction: Nipple-sparing mastectomy (NSM) is a valid option for carefully selected cases. Oncologic guidelines have not been established, but proximity of the tumor to the nipple, tumor size, lymph node involvement, and neoadjuvant chemotherapy have been suggested as contraindications to nipple preservation. This study describes our experience with NSM in relation to these factors, in particular distance of tumor from the nipple, to help establish evidence-based guidelines for NSM. Method: All NSM procedures performed at our institution between 2014 and 2018 were reviewed. The tumor-to-nipple distance was measured for each patient using mammography, ultrasound, or magnetic resonance imaging. All patients underwent a frozen section (FS) biopsy of the base of the nipple during surgery, and if cancer was detected, the procedure was converted to a skin-sparing mastectomy. Patients were followed for postoperative complications and cancer recurrence. Results: Sixty-eight patients (98 breasts) underwent NSM with immediate reconstruction. Fifty-three patients (78%) underwent the procedure for breast cancer. Nipple involvement was detected on FS in 1 patient and on permanent pathology after a negative FS in 1 patient. Forty-three percent of our patients had a tumor-to-nipple distance of ≤2 cm. During a mean follow-up of 32.5 months (±19.4 months), no locoregional recurrences were observed; however, distant metastasis occurred in 3 patients. Conclusions: When histologic examination from the base of the nipple is negative (either by FS or permanent pathology), NSM can be considered oncologically safe. Lack of nipple involvement by preoperative clinical and imaging assessment and intraoperative FS is sufficient to classify patients as suitable for NSM.

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A novel nipple–areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients

Cited by 10 publications

References 37 publications

A nomogram based on clinical factors for preoperative prediction of nipple involvement in breast cancer

A nomogram based on clinical factors for preoperative prediction of nipple involvement in breast cancer

The Associated Clinicopathologic Characteristics of Nipple-Areola Complex Involvement in Breast Cancer

Tumor-to-Nipple Distance in Selecting Patients for Nipple-sparing Mastectomy

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