Department of Pathophysiology, Shandong University School of Medicine, Shandong, China.
Ann Surg Oncol. 2012 Apr;19(4):1174-80. doi: 10.1245/s10434-011-2107-3. Epub 2011 Oct 18.
Breast-conserving therapy (BCT) is an accepted therapeutic option for most breast cancer patients. However, mastectomy is still performed in 30-50% of patients undergoing surgeries. There is increasing interest in preservation of the nipple and/or areola in hopes of achieving improved cosmetic and functional outcomes; however, the oncologic safety of nipple-areolar complex (NAC) preservation is a major concern. We sought to identify the predictive factors for NAC involvement in breast cancer patients.
We analyzed the rates and types of NAC involvement by breast carcinoma, and its association with other clinicopathologic features of the tumors in 787 consecutive therapeutic mastectomies performed at our institution between 1997 and 2009.
Among these, 75 cases (9.5%) demonstrated NAC involvement. Only 21 (28%) of 75 of cases with NAC involvement could be identified grossly by inspection of the surgical specimen (seven of these had been clinically identified). NAC involvement was most significantly associated with tumors located in all four quadrants (P<0.0001), tumors>5 cm in size (P=0.0014 for invasive carcinoma and P=0.0032 for in-situ carcinoma), grade 3 tumors (P=0.0192), tumors with higher nuclear grades (P=0.0184), and tumors with HER2 overexpression (P=0.0137).
On the basis of our findings, we have developed a mathematical model that is based on the extent and location of the tumor, HER2 expression, and nuclear grade that predicts the probability of NAC involvement by breast cancer. This model may aid in preoperative planning in selecting appropriate surgical procedures based on an individual patient's relative risk of NAC involvement.
保乳疗法（BCT）是大多数乳腺癌患者可接受的治疗选择。然而，仍有 30-50%的手术患者接受乳房切除术。人们越来越关注保留乳头和/或乳晕，以期获得更好的美容和功能效果；然而，乳头乳晕复合体（NAC）保留的肿瘤学安全性是一个主要关注点。我们旨在确定乳腺癌患者 NAC 受累的预测因素。
我们分析了 787 例连续接受治疗性乳房切除术的患者中乳腺癌的 NAC 受累率和类型，及其与肿瘤其他临床病理特征的关系，这些患者于 1997 年至 2009 年在我们机构接受治疗。
其中，75 例（9.5%）存在 NAC 受累。仅在 75 例 NAC 受累病例中，有 21 例（28%）可通过手术标本的肉眼检查识别（其中 7 例已临床识别）。NAC 受累与肿瘤位于四个象限（P<0.0001）、肿瘤>5 厘米（浸润性癌 P=0.0014，原位癌 P=0.0032）、3 级肿瘤（P=0.0192）、核级较高的肿瘤（P=0.0184）和 HER2 过表达的肿瘤（P=0.0137）显著相关。
基于我们的发现，我们开发了一种基于肿瘤的范围和位置、HER2 表达和核级的数学模型，该模型可预测乳腺癌 NAC 受累的概率。该模型可帮助术前规划，根据患者 NAC 受累的相对风险选择合适的手术程序。
