Paris, France From the Department of Surgery, Institute Curie.
Plast Reconstr Surg. 2013 May;131(5):969-984. doi: 10.1097/PRS.0b013e3182865a3c.
The role of nipple-sparing mastectomy for breast cancer is controversial, as there is concern regarding its oncologic safety and complication rate. The authors reviewed the literature to quantify the incidence of occult nipple malignancy in breast cancer, identify the factors influencing occult nipple malignancy, quantify locoregional recurrence rates, and quantify nipple-sparing mastectomy complication rates.
A search of the literature was performed using PubMed. Key words used were "mastectomy," "nipple involvement," "nipple-sparing mastectomy," "skin-sparing mastectomy," "occult nipple malignancy," "occult nipple disease," and "breast cancer recurrence." Articles were analyzed regarding incidence of occult nipple malignancy, potential factors influencing the incidence of occult malignancy, and recurrence/complications following nipple-sparing mastectomy. The incidence of occult nipple disease was compared between groups using chi-square or Fisher's exact tests for categorical variables and t tests for continuous variables. Values of p < 0.05 were considered significant.
The overall rate of occult nipple malignancy was 11.5 percent. Primary tumor characteristics influencing occult nipple malignancy were tumor-nipple distance less than 2 cm, grade, lymph node metastasis, lymphovascular invasion, human epidermal growth factor receptor-2-positive, estrogen receptor/progesterone receptor-negative, tumor size greater than 5 cm, retroareolar/central location, and multicentric tumors. The overall nipple recurrence rate considered significant was 0.9 percent, and the skin flap recurrence rate was 4.2 percent. Full- and partial-thickness nipple necrosis rates were 2.9 and 6.3 percent, respectively.
Nipple-sparing mastectomy for primary breast cancer is appropriate in carefully selected patients. All patients should have retroareolar sampling. There is strong evidence to suggest that suitable cases are well circumscribed single or multifocal lesions that have a tumor-to-nipple distance greater than 2 cm. Tumors should be grade 1 to 2 and not have lymphovascular invasion, axillary node metastasis, or human epidermal growth factor receptor-2 positivity.
保乳乳头切除术治疗乳腺癌的作用存在争议，因为人们对其肿瘤安全性和并发症发生率存在担忧。作者对文献进行了回顾，以量化乳腺癌中隐匿性乳头恶性肿瘤的发生率，确定影响隐匿性乳头恶性肿瘤的因素，量化局部区域复发率，并量化保乳乳头切除术的并发症发生率。
使用 PubMed 对文献进行了搜索。使用的关键词是“乳房切除术”、“乳头受累”、“保乳乳头切除术”、“皮肤保留乳房切除术”、“隐匿性乳头恶性肿瘤”、“隐匿性乳头疾病”和“乳腺癌复发”。分析了文章中隐匿性乳头恶性肿瘤的发生率、影响隐匿性恶性肿瘤发生率的潜在因素以及保乳乳头切除术后的复发/并发症。使用卡方检验或 Fisher 精确检验对分类变量和 t 检验对连续变量进行组间比较。p 值<0.05 被认为具有统计学意义。
隐匿性乳头恶性肿瘤的总体发生率为 11.5%。影响隐匿性乳头恶性肿瘤的主要肿瘤特征包括肿瘤-乳头距离小于 2cm、分级、淋巴结转移、脉管侵犯、人表皮生长因子受体 2 阳性、雌激素受体/孕激素受体阴性、肿瘤大小大于 5cm、乳晕后/中央位置和多中心肿瘤。被认为具有显著意义的乳头总复发率为 0.9%，皮瓣复发率为 4.2%。全层和部分层乳头坏死率分别为 2.9%和 6.3%。
在仔细选择的患者中，原发性乳腺癌的保乳乳头切除术是合适的。所有患者均应进行乳晕后取样。有强有力的证据表明，合适的病例是边界清楚的单发或多灶性病变，肿瘤-乳头距离大于 2cm。肿瘤应分级为 1 级至 2 级，且无脉管侵犯、腋窝淋巴结转移或人表皮生长因子受体 2 阳性。
