Parameters that predict nipple involvement in breast cancer11No competing interests declared.

Lambert, Paul A.; Kolm, Paul; Perry, Roger R.

doi:10.1016/s1072-7515(00)00689-x

Cited by 45 publications

(27 citation statements)

References 16 publications

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“…The nipple areolar invasion by the tumour cells is considered a major reason to avoid NAC conservation during mastectomy [16][17][18][19]. The relation between different preoperative parameters, and the presence of positive retroareolar histology is an important issue often underlined in the literature [20][21][22]. Most of these authors observe a relation between the tumour size, the tumour site, the lymph node metastases and the risk of retroareolar tumour involvement [3,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Number of articles studied the relation of nipple and areola involvement and the tumour site, the tumour size and the nodal status [3][4][5][6][7][8] but we didn't find in the literature data about the risk of retroareolar recurrence in relation with the conservation of the NAC in case of breast cancer treatment. Most of these studies concluded that the NAC could be preserved only in the case of small tumours located at a distance from the areola, and with negative axillary nodes.…”

Section: Introductionmentioning

confidence: 96%

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Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

Petit

Veronesi

Rey

et al. 2008

Breast Cancer Res Treat

145

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International audienceWhen the conservative treatment is not recommended, Nipple Sparing Mastectomy (NSM) is proposed more and more frequently for the surgical treatment of breast cancer. The risk of local recurrence behind the nipple areolar complex (NAC) is the main limiting factor of the NSM procedure. To minimize such risk, we proposed in 2002 a intraoperative radiotherapy of the preserved NAC. From March 2002 to November 2006, 579 cases (in 570 patients) of NSM were performed for carcinoma. The median follow up time was 19 months (Range: 1–60). The subcutaneous mastectomy was performed through an incision removing a portion of the skin overlying the tumour. An extemporaneous histological examination was performed on the retroareolar glandular tissue. If the histology was positive the patient was not considered eligible. Then an intraoperative radiotherapy with electrons (ELIOT) of 16 Gy in one shot was delivered on the NAC area. An immediate breast reconstruction was done using implants in most cases and in several cases a musculocutaneous flaps, usually in large breast. The number of local recurrences was recorded and the correlation between their occurrence and the clinical and histological criteria were analysed using the Gray test statistical method in a competing framework. In 516 cases the negative retroareolar frozen section biopsy was confirmed by the final histology, while in 63 cases, the final histology showed foci of carcinoma. Seven out of these 63 cases underwent a secondary NAC removal. In the 56 cases which preserved areolas we did not observe any local recurrence after 19 months follow up. The probability of retro areola positive histology increases with the tumour size. and was not related to the nodal status. The rate of local relapses was 0.9% per year. We didn't find any significant difference in the local relapse rate according to different patient's and tumour's features. Most relapses were located close to the tumour bed but never in the NAC area. Our study confirms that the local recurrence rate in the NSM completed with local radiotherapy on the NAC is not higher than the usual rate observed in the literature and the preservation of the NAC does not increase the risk. The absence of local recurrence in the region where a portion of glandular tissue has been purposely preserved is a good argument in favour of ELIOT

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

Petit

Veronesi

Rey

et al. 2008

Breast Cancer Res Treat

145

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“…Therefore, identification of patients at high risk for NAC involvement is still critical issue. Frequency of the occult NAC involvement in mastectomy specimens has been reported between 5.6 to 58% in the literature [3,[8][9][10]. Reasons of this wide range are not completely clear, but it may be due to different histopathological sampling methods used in different studies.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these are clinical nipple involvement, skin involvement, tumor location, tumor to nipple distance, tumor size, axillary lymph node status, number of positive axillary lymph nodes, histologic grade, LVI, and tumor stage [5,9,10]. In this study, age, histologic grade, estrogen and progesterone receptor status had no significant effect on NAC involvement, whereas primary tumor size, tumor location, number of positive axillary lymph nodes, and LVI were the significant risk factors in the univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Prediction of occult nipple-areola complex involvement in breast cancer patients

Gülben¹,

Yıldırım²,

Berberoğlu³

2009

neo

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The aim of this study was to evaluate predictive factors for the nipple-areola complex (NaC) involvement, and to define a subgroup of patients who may benefit from skin-sparing mastectomy with the NaC preservation in breast cancer patients. Univariate and multivariate analyses were carried out in the retrospective data of 397 eligible patients. The NaC involvement was histopathologically proved in 58 (14.6%) of the patients. In the multivariate logistic regression analysis showed that tumor location (central vs peripheral; p<0.0001; hazard ratio [HR], 7.5; 95% confidence interval [CI], 3.4-14.6), number of positive axillary lymph nodes (≥10 vs <10; p<0.005; HR, 2.9; CI, 1.3-6.1), and lymphatic vascular invasion (yes vs no; p<0.0001; HR, 3.5; CI, 1.7-7.1) were the most important prognostic factors. Whereas patients with 2 or 3 risk factors were accepted as high-risk group for the NaC involvement, those with no or 1 risk factor was defined as low-risk group. These groups had a 50.0% NaC involvement rate and a 8.1% NaC involvement rate, respectively (p<0.0001). In conclusion, this study showed that patients with 2 or 3 predictive factors had a high risk of the NaC involvement. These risk factors should be taken into consideration in patient selection for skin-sparing mastectomy with the NaC preservation.

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“…The nipple-areola complex (NAC) is an identifying characteristic of the breast [12] and conserving it decreases the feeling of mutilation when the mastectomy is required. Several authors investigating the possibility of nipple-areola preservation have evaluated the risk of tumour involvement [13][14][15][16][17][18]. The conservation of the NAC when mastectomy is indicated has always been criticised because of the risk of recurrences.…”

Section: Introductionmentioning

confidence: 99%

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

Veronesi²,

Orecchia

et al. 2009

Breast Cancer Res Treat

214

138

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In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%.Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1-69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.

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Parameters that predict nipple involvement in breast cancer11No competing interests declared.

Cited by 45 publications

References 16 publications

Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

Prediction of occult nipple-areola complex involvement in breast cancer patients

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

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