Division of Breast Surgery, Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd., NW, PHC Building, 4th Floor, Washington, DC, 20007, USA.
Ann Surg Oncol. 2018 Aug;25(8):2303-2307. doi: 10.1245/s10434-018-6569-4. Epub 2018 Jun 15.
The aim of this study is to describe a less aggressive approach to management of positive nipple margin following nipple-sparing mastectomy (NSM), allowing for preservation of the nipple-areolar complex (NAC).
A single-institution retrospective chart review was performed for patients undergoing NSM from 1989 to 2017. Positive nipple margin was defined as any residual invasive carcinoma or ductal carcinoma in situ (DCIS) within the additional nipple margin. Management included complete NAC removal, subareolar shave biopsy, or observation alone. Primary outcomes included rates of positive nipple margin and local recurrence.
A total of 819 breasts underwent NSM, yielding a total of 32 breasts (3.9%) with positive nipple margin. Management included 11 (34.4%) subareolar shave biopsies, 15 (46.9%) complete NAC excisions, and 5 (15.6%) with observation alone, plus 1 (3.1%) lost to follow-up. Final pathology after subareolar shave biopsy did not reveal any residual disease, and no patients developed NAC necrosis or required NAC removal. Final pathology after NAC excision revealed 3 of 15 with additional disease (1 invasive ductal carcinoma, 2 DCIS). Of the five patients who had no subsequent intervention, tumor pathology was DCIS in all cases. One patient received adjuvant radiation therapy. Mean time to intervention was 3.7 ± 1.9 with mean follow-up of 2.9 years.
Management of positive nipple margin after NSM with subareolar shave biopsy is a safe alternative to preserve the NAC.
本研究旨在描述一种对保留乳头乳晕复合体（NAC）的保乳乳头切除术（NSM）后阳性乳头边缘更为积极的管理方法。
对 1989 年至 2017 年期间接受 NSM 的患者进行了单机构回顾性图表回顾。阳性乳头边缘定义为额外乳头边缘内存在任何残留的浸润性癌或导管原位癌（DCIS）。管理包括完全切除 NAC、乳晕下磨皮活检或单独观察。主要结局包括阳性乳头边缘和局部复发的发生率。
共有 819 例乳房接受了 NSM，共有 32 例（3.9%）出现阳性乳头边缘。管理包括 11 例（34.4%）乳晕下磨皮活检、15 例（46.9%）完全切除 NAC 和 5 例（15.6%）单独观察，外加 1 例（3.1%）失访。乳晕下磨皮活检后的最终病理未发现任何残留疾病，且无患者发生 NAC 坏死或需要切除 NAC。NAC 切除后的最终病理显示 15 例中有 3 例有额外疾病（1 例浸润性导管癌，2 例 DCIS）。在未进行后续干预的 5 例患者中，所有病例的肿瘤病理均为 DCIS。1 例患者接受了辅助放疗。平均干预时间为 3.7±1.9 年，平均随访时间为 2.9 年。
在 NSM 后行乳晕下磨皮活检以保留 NAC 是一种安全的替代方法。
