Dent Briar L, Miller Jake A, Eden Daniel J, Swistel Alexander, Talmor Mia
New York, N.Y.
From the Divisions of Plastic Surgery and Breast Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine.
Plast Reconstr Surg. 2017 Jul;140(1):1e-8e. doi: 10.1097/PRS.0000000000003414.
A tumor-to-nipple distance of greater than 2 cm has traditionally been considered a criterion for nipple-sparing mastectomy. This study evaluates whether magnetic resonance imaging and sonographic measurements of tumor-to-nipple distance accurately reflect the risk of nipple involvement by disease.
All nipple-sparing mastectomy cases with implant-based reconstruction performed by the senior author between July 2006 and December 2014 were retrospectively reviewed. Therapeutic cases with preoperative magnetic resonance imaging or sonography were included.
One hundred ninety-five cases were included. Preoperative imaging consisted of sonography (n = 169), magnetic resonance imaging (n = 152), or both (n = 126). With sonography, nipple involvement did not differ between nipple-sparing mastectomy candidates and noncandidates using a tumor-to-nipple distance cutoff of 2 cm (10.7 percent versus 10.6 percent; p = 0.988) or 1 cm (9.3 percent versus 15.0 percent; p = 0.307). With magnetic resonance imaging, nipple involvement did not differ between candidates and noncandidates using a cutoff of 2 cm (11.6 percent versus 12.5 percent; p = 0.881) or 1 cm (11.4 percent versus 13.8 percent; p = 0.718). When sonography and magnetic resonance imaging findings were both available and concordant, nipple involvement still did not differ between candidates and noncandidates using a cutoff of 2 cm (8.8 percent versus 11.8 percent; p = 0.711) or 1 cm (7.6 percent versus 14.3 percent; p = 0.535).
A tumor-to-nipple distance as small as 1 cm, as measured by sonography or magnetic resonance imaging, should not be considered a contraindication to nipple-sparing mastectomy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
传统上，肿瘤与乳头距离大于2 cm被视为保乳手术的一项标准。本研究评估磁共振成像和超声测量的肿瘤与乳头距离能否准确反映疾病累及乳头的风险。
回顾性分析2006年7月至2014年12月期间由资深作者实施的所有采用植入物重建的保乳手术病例。纳入术前有磁共振成像或超声检查的治疗病例。
共纳入195例病例。术前成像检查包括超声（n = 169）、磁共振成像（n = 152）或两者皆有（n = 126）。对于超声检查，以2 cm为肿瘤与乳头距离的临界值，保乳手术候选者与非候选者的乳头受累情况无差异（10.7%对10.6%；p = 0.988）；以1 cm为临界值时亦无差异（9.3%对15.0%；p = 0.307）。对于磁共振成像，以2 cm为临界值，候选者与非候选者的乳头受累情况无差异（11.6%对12.5%；p = 0.881）；以1 cm为临界值时同样无差异（11.4%对13.8%；p = 0.718）。当超声和磁共振成像结果均可用且一致时，以2 cm为临界值，候选者与非候选者的乳头受累情况仍无差异（8.8%对11.8%；p = 0.711）；以1 cm为临界值时也无差异（7.6%对14.3%；p = 0.535）。
超声或磁共振成像测量的肿瘤与乳头距离小至1 cm，不应被视为保乳手术的禁忌证。
临床问题/证据级别：风险，II级。
