Predictors of occult nipple–areola complex involvement in breast cancer patients: clinicopathologic study

Context
Although oncoplastic breast-conserving surgery is a standard approach for treatment of breast cancer patients, mastectomy is still performed in 20–30% of patients undergoing surgeries. Nipple-sparing mastectomy provides a cosmetic and psychological outcome for patients; however, the oncologic safety of nipple–areola complex (NAC) sparing is a major concern.
Aim
The focus of this study was to determine the predictive factors of NAC involvement to define the indicators for NAC preservation.
Patients and methods
We analyzed NAC involvement in 180 patients during the period between October 2013 and December 2016 as regards the relation between the pathological affection of the NAC and clinical criteria, pathological and molecular features of the tumor (size, site, tumor–nipple distant, nodal affection, and molecular classification of breast cancer).
Results
Among 180 patients, 38 (21.1%) demonstrated NAC involvement, and it was mostly associated with tumor size 4 cm (=0.047), tumor–nipple distant of 2.5 cm (=0.003), positive lymph node (=0.05), negative estrogen receptor (=0.00013), negative progesterone receptors (=0.000001), and HER2 receptor overexpression (=0.001). Triple-negative breast cancer was significantly associated with increased risk of NAC involvement followed by HER2/neu-enriched subtype (=0.001).
Conclusion
Tumor–nipple distant, tumor size and state of lymph nodes are the most important clinical predictors of nipple involvement and should be considered as risk factors. At the pathological and molecular level, triple-negative breast cancer is the worst subtype. The presence of one or more of these factors indicates high risk of occult nipple invasion.