Departments of *Surgical Oncology †Pathology, Erasmus MC Cancer Institute, Rotterdam Departments of ‡Pathology ∥Surgery, Albert Schweitzer Hospital, Dordrecht §Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Am J Surg Pathol. 2014 May;38(5):706-12. doi: 10.1097/PAS.0000000000000180.
Prophylactic skin-sparing mastectomy (SSM) is associated with major breast cancer risk reduction in high-risk patients. In prophylactic nipple-sparing mastectomy (NSM) it is unknown how many terminal duct lobular units (TDLUs) remain behind the nipple-areola complex (NAC) additionally to those behind the skin flap. Therefore, safety of NSM can be doubted. We compared amounts of TDLUs behind the NAC as compared with the skin. In prophylactic SSM and conventional therapeutic mastectomy patients, the NAC and an adjacent skin island (SI) were resected as if it were an NSM. NAC and SI were serially sectioned perpendicularly to the skin and analyzed for the amount of TDLUs present. Slides of NAC and SI were scanned, and slide surface areas (cm) were measured. TDLUs/cm in NAC versus SI specimen, representing TDLU density, were analyzed pairwise. In total, 105 NACs and SIs of 90 women were analyzed. Sixty-four NACs (61%) versus 25 SIs (24%) contained ≥1 TDLUs. Median TDLU density was higher in NAC specimens (0.2 TDLUs/cm) as compared with SI specimens (0.0 TDLUs/cm; P<0.01). Independent risk factors for the presence of TDLUs in the NAC specimen were younger age and parity (vs. nulliparity). The finding of higher TDLU density behind the NAC as compared with the skin flap suggests that sparing the NAC in prophylactic NSM in high-risk patients possibly may increase postoperative breast cancer risk as compared with prophylactic SSM. Studies with long-term follow-up after NSM are warranted to estimate the level of residual risk.
预防性保留乳头乳晕的乳房切除术（NSM）与高危患者的乳腺癌风险降低密切相关。在预防性保留乳头乳晕的乳房切除术（NSM）中，尚不清楚乳头乳晕复合体（NAC）后面除了皮瓣后面还有多少终末导管小叶单位（TDLUs）。因此，NSM 的安全性可能受到怀疑。我们比较了 NAC 后面的 TDLU 数量与皮肤后面的 TDLU 数量。在预防性 SSM 和常规治疗性乳房切除术患者中，NAC 和相邻的皮肤岛（SI）被切除，就像进行 NSM 一样。NAC 和 SI 沿垂直于皮肤的方向进行连续切片，并分析存在的 TDLU 数量。NAC 和 SI 的切片被扫描，并测量切片表面积（cm）。分析 NAC 和 SI 标本中 TDLU/cm 的数量，代表 TDLU 密度，进行成对比较。总共分析了 90 名女性的 105 个 NAC 和 SI。64 个 NAC（61%）中有≥1 个 TDLU，而 25 个 SI（24%）中有≥1 个 TDLU。NAC 标本的 TDLU 密度中位数（0.2 TDLUs/cm）高于 SI 标本（0.0 TDLUs/cm；P<0.01）。NAC 标本中存在 TDLU 的独立危险因素是年龄较小和生育（与未生育相比）。与皮瓣相比，NAC 后面 TDLU 密度较高的发现表明，在高危患者的预防性 NSM 中保留 NAC 可能会增加术后乳腺癌的风险，与预防性 SSM 相比。需要进行长期随访的 NSM 研究来评估残留风险水平。
