Cont Nicoletta Tomasi, Maggiorotto Furio, Martincich Laura, Rivolin Alessandro, Kubatzki Franziska, Sgandurra Paola, Marocco Francesco, Magistris Alessandra, Gatti Marco, Balmativola Davide, Montemurro Filippo, Sapino Anna, Ponzone Riccardo
Gynecological Oncology, Candiolo Cancer Institute-FPO, IRCCS, Str. Prov. 142, km 3.95, I-10060, Candiolo (Turin), Italy.
Radiology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo (Turin), Italy.
Breast Cancer Res Treat. 2017 Aug;165(1):85-95. doi: 10.1007/s10549-017-4312-7. Epub 2017 May 28.
To assess the oncological safety of nipple-areola complex (NAC) sparing mastectomy in breast cancer patients.
From 2010 to 2015, 518 breast cancer patients were submitted to NAC sparing mastectomy. Breast MRI and intraoperative assessment of the subareolar (SD) and proximal (ND) nipple ducts were performed to predict NAC involvement. Significant associations between pre- and postoperative variables with SD/ND involvement and with the risk of local recurrence were retrospectively investigated.
SD/ND were involved in 26.1% of the cases. Final pathology of SD/ND was predicted by tumor-NAC distance at MRI and intraoperative pathology with 75 and 93% accuracy, respectively. NAC involvement was more frequent in case of positive ND than positive SD (68.3 vs. 38.3%; p = 0.003). Fourteen (2.7%) local relapses developed over a mean follow-up of 33 months. Ki-67 ≥25% (p = 0.002) and high tumor grade (p = 0.027) correlated with local recurrence. Most relapses developed in the subcutaneous tissue of the quadrant where the primary tumor was located (12/14; 85.7%). No local relapses occurred in patients who received post-mastectomy radiotherapy as compared to patients who did not, although they had a higher rate of positive surgical margins (40.5 vs. 16.2%; p = 0.000).
NAC involvement can be predicted by MRI and intraoperative pathology of ND/SD. Local recurrences after NAC sparing mastectomy almost invariably develop in the same quadrant where the primary tumor was located and in highly proliferative tumors.
评估乳腺癌患者保留乳头乳晕复合体（NAC）的乳房切除术的肿瘤学安全性。
2010年至2015年，518例乳腺癌患者接受了保留NAC的乳房切除术。进行乳腺MRI以及乳晕下（SD）和乳头近端（ND）导管的术中评估，以预测NAC是否受累。回顾性研究术前和术后变量与SD/ND受累以及局部复发风险之间的显著关联。
26.1%的病例中SD/ND受累。MRI上肿瘤与NAC的距离以及术中病理对SD/ND最终病理结果的预测准确率分别为75%和93%。ND阳性的病例中NAC受累比SD阳性的病例更常见（68.3%对38.3%；p = 0.003）。在平均33个月的随访期内发生了14例（2.7%）局部复发。Ki-67≥25%（p = 0.002）和高肿瘤分级（p = 0.027）与局部复发相关。大多数复发发生在原发肿瘤所在象限的皮下组织（12/14；8
