Castellano Isabella, Metovic Jasna, Balmativola Davide, Annaratone Laura, Rangel Nelson, Vissio Elena, Arisio Riccardo, Macrì Luigia, Pecchioni Carla, Sarotto Ivana, Montarolo Francesca, Muscarà Francesca, Marchiò Caterina, Cassoni Paola, Kulka Janina, Sapino Anna
Department of Medical Sciences, University of Turin, Turin, Italy.
Fondazione del Piemonte per l'Oncologia (FPO) - Candiolo Cancer Institute (IRCCs), Candiolo, Italy.
PLoS One. 2017 Aug 14;12(8):e0182073. doi: 10.1371/journal.pone.0182073. eCollection 2017.
The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy.
We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears.
Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, χ251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, χ211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues.
Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases.
乳头溢液细胞学检查（NDc）在乳腺癌患者手术治疗中的作用尚不清楚。我们旨在：（i）评估恶性NDc对乳头乳晕复合体手术方式的影响，以及（ii）验证恶性NDc与乳头恶性肿瘤之间的关联。
我们回顾性分析了139例接受乳腺手术的NDc患者的病例系列。记录临床和组织学检查结果、以乳头乳晕复合体切除为重点的手术类型、癌的免疫组化表型以及肿瘤与乳头的距离测量值。此外，对于在确定性手术中显示HER2阳性病变的患者，我们评估了NDc涂片的HER2免疫细胞化学情况。
共确定了32例恶性和107例良性/交界性NDc诊断。所有32例恶性NDc病例经组织学确诊为恶性。30例交界性/良性NDc病例经组织学诊断为恶性（敏感性58%）。在乳房切除术和保乳手术组中，大多数恶性NDc患者均接受了乳头乳晕复合体切除术（P<0.001，χ²=51.77）。乳头受累与HER2阳性导管原位癌密切相关（P<0.001，χ²=11.98）。NDc的HER2免疫细胞化学结果与手术组织的免疫细胞化学结果显示100%的相关性。
恶性NDc影响手术治疗。恶性NDc与乳头受累的关联与HER2过表达的导管原位癌高度相关。在HER2阳性NDc的情况下，乳头乳晕复合体受累的可能性比HER2阴性病例更大。
