Chan Yolanda Ho-Yan, Yau Wai-Ming, Cheung Polly Suk-Yee
Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR.
Breast Care Centre, Hong Kong Sanatorium and Hospital, 2 Village Road, Happy Valley, Hong Kong SAR.
World J Surg. 2018 May;42(5):1375-1383. doi: 10.1007/s00268-017-4197-y.
Nipple-sparing mastectomy (NSM) has gained widespread popularity in recent years. Nonetheless, patient selection, technical consideration and oncological safety of its extension to breast cancer treatment remain uncertain. Few publications have reviewed the application of NSM in Asian populations.
We retrospectively reviewed 91 women with malignant breast tumours, who underwent 97 NSM in Hong Kong Sanatorium and Hospital from 2009 to 2015. Breast cancer patients who required mastectomy and opted for immediate reconstruction were considered for NSM if they showed no obvious nipple involvement clinically. All breast specimens were subjected to intraoperative pathological examination of the retroareolar tissue to exclude occult tumour infiltration before the final decision of nipple-areola complex (NAC) preservation. Clinical parameters, tumour characteristics and oncological outcomes were analyzed.
Carcinoma of the breast accounts for 99.0% of our indications for therapeutic NSM. Almost all NSM were accompanied with immediate reconstruction. Abnormal pathology was shown in retroareolar tissue of ten patients (10.3%), and seven of these NAC were excised due to tumour involvement detected by intraoperative frozen section. Six (6.2%) NSM were complicated with superficial epidermolysis. Yet, there was no delayed NAC excision because of nipple necrosis. Overall NAC preservation rate reached 92.8%. Local and/or distant recurrences occurred in four patients (4.1%) after a mean follow-up of 20.6 months. One NAC recurrence was documented.
Our series support the oncological safety of NSM after exclusion of neoplastic NAC involvement preliminarily by intraoperative frozen section and definitively by final pathology. Its technical feasibility is well proven by the low nipple necrosis rate.
近年来，保留乳头的乳房切除术（NSM）已广泛普及。尽管如此，其在乳腺癌治疗中的患者选择、技术考量及肿瘤学安全性仍不明确。很少有出版物综述NSM在亚洲人群中的应用。
我们回顾性分析了2009年至2015年在香港养和医院接受97例NSM的91例患有恶性乳腺肿瘤的女性。需要乳房切除术并选择即刻重建的乳腺癌患者，如果临床上未显示明显乳头受累，则考虑行NSM。所有乳房标本均在乳晕后组织进行术中病理检查，以在最终决定保留乳头乳晕复合体（NAC）之前排除隐匿性肿瘤浸润。分析临床参数、肿瘤特征及肿瘤学结局。
乳腺癌占我们治疗性NSM适应证的99.0%。几乎所有NSM均伴有即刻重建。10例患者（10.3%）乳晕后组织病理异常，其中7例NAC因术中冰冻切片检测到肿瘤累及而被切除。6例（6.2%）NSM并发表皮浅层松解。然而，没有因乳头坏死而延迟切除NAC。总体NAC保留率达到92.8%。平均随访20.6个月后，4例患者（4.1%）出现局部和/或远处复发。记录到1例NAC复发。
我们的系列研究支持通过术中冰冻切片初步排除肿瘤性NAC累及并最终经病理确诊后NSM的肿瘤学安全性。其技术可行性通过低乳头坏死率得到了充分证明。
