Preoperative Predictors of Nipple–Areola Complex Involvement for Patients Undergoing Mastectomy for Breast Cancer

Billar, Julie A Y; Dueck, Amylou C.; Gray, Richard; Wasif, Nabil; Pockaj, Barbara A.

doi:10.1245/s10434-011-2008-5

Cited by 42 publications

(36 citation statements)

References 20 publications

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“…The rates of tumour NAC involvement in the literature are inconsistent [14][15][16][17][18][19][20][21] likely due to different pathological protocols for NAC evaluation and variable accuracy of clinical and pathological data collection. For example, a recent systematic review of the literature showed that only 6.4% of the nipple cores of 2477 NAC sparing mastectomies were involved with tumour [13].…”

Section: Discussionmentioning

confidence: 99%

“…The likelihood of NAC involvement has been associated with several tumour characteristics such as retroareolar location, distance from the NAC, size, multifocality/mul ticentricity, grade, lympho-vascular invasion, extensive intraductal component and lymph-nodal status [14][15][16][17]. We recently showed that tumour-NAC distance measured by magnetic resonance imaging (MRI) of the breast is the key preoperative predictor of NAC involvement in a series of total mastectomies performed at our Institution [18].…”

Section: Introductionmentioning

confidence: 99%

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MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Ponzone

Carabalona

Rivolin

et al. 2015

European Journal of Cancer

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Background: Nipple-areola sparing mastectomy (NSM) with immediate implant reconstruction is an option for patients with non-locally advanced breast cancer. The prediction of occult tumour involvement of the nipple-areola complex (NAC) may help select candidates to NSM. Patients and methods: We prospectively recorded clinical and pathological data, magnetic resonance imaging (MRI) results and intraoperative pathological assessments of the subareolar (SD) and proximal nipple ducts (ND) of 112 consecutive breast cancer patients scheduled for NSM. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. Results: Thirty-one patients (27.7%) had tumour involvement of the NAC. At univariate analysis, age (p = 0.001), post-menopausal status (0.003), tumour central location (p = 0.03), tumour-NAC distance measured by MRI (p = 0.000) and intraoperative pathologic assessment (SD + ND) (p = 0.000) were significantly correlated with NAC involvement. At multivariate analysis, only MRI tumour-NAC distance (p = 0.008) and menopausal status (p = 0.039) among all preoperative variables retained statistical significance. The sensitivity and specificity of MRI tumour-NAC distance were 32.2% and 88.6% and those of E-mail address: riccardo.ponzone@ircc.it (R. Ponzone).European Journal of Cancer (2015) 51, 1882-1889 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m intraoperative pathologic assessment were 46.7% and 100%, respectively. Sensitivity, specificity and accuracy of the double assessment (MRI plus intraoperative pathology) were 50.0%, 96.2% and 84.1%, respectively. Conclusion: Intraoperative pathologic assessment and tumour-NAC distance measured by MRI are the most important predictors of occult NAC involvement in breast cancer patients. A negative pathological assessment and a tumour-NAC distance P 5 mm allow optimal discrimination between NAC positive and NAC negative cases and may serve as a guide for the optimal planning of oncological and reconstructive surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Ponzone

Carabalona

Rivolin

et al. 2015

European Journal of Cancer

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Dull

Conant

Myckatyn

et al. 2017

Molecular and Clinical Oncology

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Abstract. Nipple-sparing mastectomies (NSMs) are increasingly used in the surgical treatment of patients with breast cancer and for prevention of breast cancer. The present study was performed to review the outcomes of patients undergoing NSMs at a single large university setting. A retrospective chart review was performed on all patients undergoing NSMs from 2008-2014. Charts were reviewed for demographic data and patient characteristics. Tumor and breast size, cancer recurrence and complications were also evaluated. Descriptive statistics were utilized to summarize the findings. From 2008From -2014 NSMs. The mean patient age was 44.4 years (range, 20-77). The average body mass index was 24 (range, 18-47). Breast weight was available for 106 specimens, with a mean weight of 475.5 g (range, 124.1-1,625.0 g). Seventy-three NSMs were performed for cancer and 124 were performed prophylactically. The mean tumor width was 1.38 cm (range, 0-6.0 cm), with an average nipple to tumor distance of 5.87 cm (range, 2.93-10.0 cm). Three (4%) patients required removal of the nipple areolar complex (NAC) due to pathological extension of the tumor. A total of 34 (17.2%) complications occurred, including infections, hematomas and nipple necrosis, with 9 requiring removal of the NAC and 13 requiring removal of the tissue expander or implant. Smokers had a 36.0% (9/25) complication rate, compared with 14.5% (25/172) of nonsmokers (P<0.05). During follow-up, one recurrence was noted, located on the chest wall. There were no recurrences in the NAC group. Therefore, NSMs may safely be performed without compromising oncologic outcomes or increasing complication rates in properly selected patients.

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“…Accepted risk factors include large tumor size, short tumor-nipple distance, multifocal or multicentric location, lymphovascular or lymph node involvement, and positive HER2 status. 12,15,[23][24][25][26][27] Thus, NSM is most frequently used in cases of prophylaxis or early disease, although it has also been used safely in advanced disease. 28 The surgeon's decision to preserve the nipple at the time of NSM is guided by the results of an intraoperative subareolar biopsy, which is taken to rule-out occult nipple malignancy.…”

Section: Discussionmentioning

confidence: 99%

Nipple Resection and Reconstruction After Attempted Nipple-Sparing Mastectomy

Dent

Chao

Eden

et al. 2017

Annals of Plastic Surgery

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Preoperative Predictors of Nipple–Areola Complex Involvement for Patients Undergoing Mastectomy for Breast Cancer

Abstract: Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.

Cited by 42 publications

References 20 publications

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

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

Nipple Resection and Reconstruction After Attempted Nipple-Sparing Mastectomy

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