Rusby J E, Brachtel E F, Othus M, Michaelson J S, Koerner F C, Smith B L
Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Br J Surg. 2008 Nov;95(11):1356-61. doi: 10.1002/bjs.6349.
This prospective study aimed to build a predictive model using preoperative information to aid selection for nipple-sparing mastectomy.
Two hundred consecutive skin-sparing mastectomy specimens without overt nipple involvement were evaluated. Demographic, preoperative pathology and imaging information was collected. Nipple specimens (2 x 2 x 2 cm) were sectioned at 3-mm intervals. Haematoxylin and eosin-stained slides were examined by a breast pathologist for involvement by tumour. Logistic regression analyses of 65 therapeutic procedures identified factors associated with occult involvement and created a predictive model. This was tested on specimens from a further 65 therapeutic procedures.
Occult nipple involvement was noted in 32 (24.6 per cent) of 130 mastectomy specimens. In the training set, imaging diameter of the lesion and its distance from the nipple predicted nipple involvement on univariable analysis (P = 0.011 and P = 0.014 respectively). The multivariable logistic regression model was validated in the test set. The areas under the receiver-operating characteristic curve were 0.824 and 0.709 for the training and test sets respectively.
Three-quarters of women undergoing mastectomy did not have occult nipple involvement. A clinical tool including tumour size and distance from the nipple has been developed to improve patient selection for nipple-sparing mastectomy.
这项前瞻性研究旨在利用术前信息建立一个预测模型，以辅助保留乳头的乳房切除术的选择。
对200例连续的未明显累及乳头的保留皮肤乳房切除术标本进行评估。收集人口统计学、术前病理和影像学信息。将乳头标本（2×2×2厘米）按3毫米间隔切片。由一位乳腺病理学家检查苏木精和伊红染色的玻片，以确定是否有肿瘤累及。对65个治疗程序进行逻辑回归分析，确定与隐匿性累及相关的因素，并建立一个预测模型。在另外65个治疗程序的标本上对其进行测试。
在130例乳房切除术标本中，有32例（24.6%）发现隐匿性乳头累及。在训练集中，病变的影像学直径及其与乳头的距离在单变量分析中可预测乳头累及（分别为P = 0.011和P = 0.014）。多变量逻辑回归模型在测试集中得到验证。训练集和测试集的受试者操作特征曲线下面积分别为0.824和0.709。
四分之三接受乳房切除术的女性没有隐匿性乳头累及。已开发出一种包括肿瘤大小和与乳头距离的临床工具，以改善保留乳头乳房切除术的患者选择。
