Prediction of nipple and areola complex invasion in breast cancer patients: clinical and pathological study of surgical specimens

Lotfy Mokhtar, Wael Elsayed; Ismail, Adel Mohamed; El Gharbawi, Mohamed Ahmed; El-Alfy, Yehia Ali; Abdelwahab, Mai Mohammed

doi:10.4103/ejs.ejs_56_17

Prediction of nipple and areola complex invasion in breast cancer patients: clinical and pathological study of surgical specimens

Authors

Abstract

Background
Nipple–areola sparing (NAS) mastectomy is nowadays considered the most common conservative procedure used for both risk reduction (prophylaxis) and cancer treatment. We regard the oncological safety as a first concern in the management of breast cancer (BC) patients.
Aim
The aim of this study was to assess the predictive value of clinical and pathological criteria that might affect decision making for NAS mastectomy in BC patients.
Patients and methods
This study included 60 cases of operable BC that underwent MRM. All specimens were subjected to histopathological examination of the subareolar tissue to prove or disprove malignant infiltration of the nipple–areola complex (NAC), and their data were plotted against the preoperative predictive factors.
Results
The incidence of occult NAC malignancy was 15%. Predictive factors influencing NAC invasion were tumour–nipple distance less than 4 cm, grade III tumour, lymph node metastasis, lymphovascular invasion, human epidermal growth factor receptor-2 positivity, oestrogen receptor/progesterone receptor negativity, retroareolar/centrally located tumour and multicentric tumours.
Conclusion
NAS mastectomy for the management of BC would be appropriate in carefully selected patients who have peripherally located tumours, grade I or II, not multicentric or multifocal, with tumour-to-nipple distance greater than 4 cm, and human epidermal growth factor receptor-2 negative with no lymphovascular invasion of the subareolar plexus or axillary lymph nodes metastasis.

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