Predictors of Nipple–Areolar Complex Involvement by Breast Carcinoma: Histopathologic Analysis of 787 Consecutive Therapeutic Mastectomy Specimens

Abstract

BackgroundBreast-conserving therapy (BCT) is an accepted therapeutic option for most breast cancer patients. However, mastectomy is still performed in 30–50% of patients undergoing surgeries. There is increasing interest in preservation of the nipple and/or areola in hopes of achieving improved cosmetic and functional outcomes; however, the oncologic safety of nipple–areolar complex (NAC) preservation is a major concern. We sought to identify the predictive factors for NAC involvement in breast cancer patients.MethodsWe analyzed the rates and types of NAC involvement by breast carcinoma, and its association with other clinicopathologic features of the tumors in 787 consecutive therapeutic mastectomies performed at our institution between 1997 and 2009.ResultsAmong these, 75 cases (9.5%) demonstrated NAC involvement. Only 21 (28%) of 75 of cases with NAC involvement could be identified grossly by inspection of the surgical specimen (seven of these had been clinically identified). NAC involvement was most significantly associated with tumors located in all four quadrants (P < 0.0001), tumors >5 cm in size (P = 0.0014 for invasive carcinoma and P = 0.0032 for in-situ carcinoma), grade 3 tumors (P = 0.0192), tumors with higher nuclear grades (P = 0.0184), and tumors with HER2 overexpression (P = 0.0137).ConclusionsOn the basis of our findings, we have developed a mathematical model that is based on the extent and location of the tumor, HER2 expression, and nuclear grade that predicts the probability of NAC involvement by breast cancer. This model may aid in preoperative planning in selecting appropriate surgical procedures based on an individual patient’s relative risk of NAC involvement.

Accuracy of frozen section, imprint cytology, and permanent histology of sub-nipple tissue for predicting occult nipple involvement in patients with breast carcinoma

“…Based on the largest reports in the literature, if surgeons performed NSM on all breast cancer patients, about 7-21 % would retain occult nipple involvement [14,[17][18][19], a similar rate was found in our study (11.7 %). Therefore, several predictive factors for nipple involvement have been determined, such as distance between tumor and nipple, tumor size, tumor location, lymphovascular invasion, ductal carcinoma in situ component, HER-2, and tumor grade [19][20][21].…”

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

“…The terminal duct lobular unit has been identified as the location for the development of all breast cancer, and a 2008 study identified the presence of terminal duct lobular units in the nipples of 9% of patients (10,11). The rate of occult malignancy detected in the NAC in mastectomy specimens has varied widely with studies reporting an incidence of 1-31% (12)(13)(14)(15)(16). Over the years, a number of prospective and retrospective studies have demonstrated a cancer recurrence rate in the NAC of up to 2%, with local recurrence rates ranging from 1-6% (17)(18)(19).…”

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

“…First described by Freeman in the 1960s as a subcutaneous mastectomy with NAC sparing, the author indicatIn addition, some clinical series observed that nipple involvement in mastectomy specimens ranges from 0% to 58% [12,38,[42][43][44][45][46][47][48][49][50][51][52][53][54] (Table 1). One might surmise that this wide range is chiefly due to divergences in techniques used for pathology tests of the breast specimens, differences in technique and subgroup of patient populations.…”

“…Boneti et al [26] reported in a series Santini et al [45] 1989 1291 12 Menon et al [46] 1989 33 58 Verma et al [47] 1997 26 0 Vyas et al [42] 1998 140 16 Laronga et al [38] 1999 246 5.6 Simmons et al [43] 2002 217 10.6 Loewen et al [48] 2008 302 10 Rusby et al [53] 2008 130 24.6 Banerjee et al [49] 2008 219 20 Voltura et al [50] 2008 34 5.9 Pirozzi et al [51] 2010 50 28 Reynolds et al [52] 2011 29 7 Wang et al [54] 2012 787 7…”