Byon Wooseok, Kim Eunyoung, Kwon Junseong, Park Yong Lai, Park Chanheun
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Breast Cancer. 2014 Dec;17(4):386-92. doi: 10.4048/jbc.2014.17.4.386. Epub 2014 Dec 26.
Nipple sparing mastectomy provides good cosmetic results and low local recurrence rates for breast cancer patients. However, there is a potential risk of leaving an occult tumor within the nipple, which could lead to cancer relapse and poor prognosis for the patient. The objective of this study was to investigate the occult nipple involvement rate in mastectomy specimens, and to identify preoperative magnetic resonance imaging (MRI) findings and the clinicopathological characteristics of the primary tumor that may correlate with nipple invasion.
Four hundred sixty-six consecutive mastectomy samples with grossly unremarkable nipples were evaluated. Demographic and clinicopathological data were collected. Nipple involvement was evaluated using serial histological sections. The tumor size and tumor-nipple distance were measured using preoperative MRI images.
Thirty-six of the 466 therapeutic mastectomy specimens (7.7%) were found to have occult nipple involvement. In univariate analysis, tumor size, tumor-nipple distance, lymph node status, p53 mutation, and lymphovascular invasion (LVI) were found to influence the likelihood of nipple involvement. Multivariate logistic regression analysis, adjusted by lymph node status, p53 mutation, and LVI, showed that tumor size and tumor-nipple distance were predictive factors indicating nipple involvement. With regard to tumor location, only tumors in the central area of the breast showed a significant association with nipple involvement.
In this study, a statistically significant association was found between occult nipple involvement and tumor size, tumor-nipple distance, axillary lymph node status, LVI, and p53 mutation. A cutoff point of 2.2 cm for tumor size and 2 cm for tumor-nipple distance could be used as parameters to predict occult nipple involvement.
保留乳头的乳房切除术能为乳腺癌患者带来良好的美容效果和较低的局部复发率。然而，存在乳头内遗留隐匿性肿瘤的潜在风险，这可能导致癌症复发并对患者预后不利。本研究的目的是调查乳房切除标本中隐匿性乳头受累率，并确定术前磁共振成像（MRI）表现以及可能与乳头侵犯相关的原发肿瘤的临床病理特征。
对466例乳头外观无明显异常的连续乳房切除样本进行评估。收集人口统计学和临床病理数据。通过连续组织学切片评估乳头受累情况。利用术前MRI图像测量肿瘤大小和肿瘤与乳头的距离。
466例治疗性乳房切除标本中有36例（7.7%）存在隐匿性乳头受累。单因素分析发现，肿瘤大小、肿瘤与乳头的距离、淋巴结状态、p53突变和淋巴管侵犯（LVI）会影响乳头受累的可能性。经淋巴结状态、p53突变和LVI校正的多因素逻辑回归分析显示，肿瘤大小和肿瘤与乳头的距离是提示乳头受累的预测因素。关于肿瘤位置，仅乳房中央区域的肿瘤与乳头受累有显著关联。
在本研究中，发现隐匿性乳头受累与肿瘤大小、肿瘤与乳头的距离、腋窝淋巴结状态、LVI和p53突变之间存在统计学上的显著关联。肿瘤大小的截断值为2.2 cm，肿瘤与乳头距离的截断值为2 cm可作为预测隐匿性乳头受累的参数。
