Department of Pathology, Mayo Clinic, Division of Anatomic Pathology, Rochester, MN, USA.
Ann Surg Oncol. 2011 Oct;18(11):3102-9. doi: 10.1245/s10434-011-1908-8. Epub 2011 Sep 27.
Use of nipple-sparing mastectomy (NSM) is increasing. We sought to look at the role of NSM in BRCA mutation carriers.
Tissue from women with a BRCA1 or BRCA2 mutation who underwent mastectomy between March 1987 and June 2009 at a single institution was reviewed. The entire nipple-areolar complex (NAC) was excised and histologically evaluated. The presence of terminal duct lobular units (TDLUs) and premalignant or malignant lesions in the NAC was noted.
Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24%) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7%) had malignant findings and 1 (3%) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct.
The probability of nipple involvement by premalignant or malignant lesions in the NAC of BRCA mutation carriers is low at time of prophylactic mastectomy, but higher (10%) in women undergoing therapeutic mastectomy. NSM may be appropriate and oncologically safe for selected women with BRCA mutations. However, 24% of NACs contained TDLUs, with only 8% found in the nipple papilla; the significance of this for long-term risk is unknown.
保乳乳头切除术（NSM）的应用正在增加。我们旨在研究 NSM 在 BRCA 突变携带者中的作用。
回顾了一家机构在 1987 年 3 月至 2009 年 6 月期间接受乳房切除术的 BRCA1 或 BRCA2 突变妇女的组织。切除整个乳头乳晕复合体（NAC）并进行组织学评估。记录 NAC 中终末导管小叶单位（TDLUs）和癌前或恶性病变的存在。
对 33 名妇女（25 名 BRCA1，8 名 BRCA2）的 62 个 NAC 进行了研究。15 个（24％）NAC 标本中存在 TDLUs。在 33 例预防性乳房切除术标本中均未发现非典型性增生、原位癌或浸润性癌。在 29 例有癌症和可用组织的乳房中，2 例（7％）NAC 有恶性发现，1 例（3％）有非典型性小叶增生。一名接受双侧浸润性癌双侧乳房切除术的妇女有一个乳头有肿瘤在淋巴管内，她对侧乳头有非典型小叶增生。另一名妇女患有涉及单个主要输乳管的原位导管癌。
BRCA 突变携带者预防性乳房切除时，NAC 中癌前或恶性病变累及乳头的概率较低（10％），但在接受治疗性乳房切除术的妇女中较高（10％）。NSM 可能适合并在肿瘤学上安全选择具有 BRCA 突变的女性。然而，24％的 NAC 包含 TDLUs，其中只有 8％位于乳头乳突；这对长期风险的意义尚不清楚。
