Kracoff-Sella Sharon L, Allweis Tanir M, Bokov Inna, Kadar-Sfarad Hadas, Shifer Yehonatan, Golzman Evgenia, Egozi Dana
Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel.
Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Plast Reconstr Surg Glob Open. 2020 Jul 21;8(7):e2963. doi: 10.1097/GOX.0000000000002963. eCollection 2020 Jul.
Nipple-sparing mastectomy (NSM) is a valid option for carefully selected cases. Oncologic guidelines have not been established, but proximity of the tumor to the nipple, tumor size, lymph node involvement, and neoadjuvant chemotherapy have been suggested as contraindications to nipple preservation. This study describes our experience with NSM in relation to these factors, in particular distance of tumor from the nipple, to help establish evidence-based guidelines for NSM.
All NSM procedures performed at our institution between 2014 and 2018 were reviewed. The tumor-to-nipple distance was measured for each patient using mammography, ultrasound, or magnetic resonance imaging. All patients underwent a frozen section (FS) biopsy of the base of the nipple during surgery, and if cancer was detected, the procedure was converted to a skin-sparing mastectomy. Patients were followed for postoperative complications and cancer recurrence.
Sixty-eight patients (98 breasts) underwent NSM with immediate reconstruction. Fifty-three patients (78%) underwent the procedure for breast cancer. Nipple involvement was detected on FS in 1 patient and on permanent pathology after a negative FS in 1 patient. Forty-three percent of our patients had a tumor-to-nipple distance of ≤2 cm. During a mean follow-up of 32.5 months (±19.4 months), no locoregional recurrences were observed; however, distant metastasis occurred in 3 patients.
When histologic examination from the base of the nipple is negative (either by FS or permanent pathology), NSM can be considered oncologically safe. Lack of nipple involvement by preoperative clinical and imaging assessment and intraoperative FS is sufficient to classify patients as suitable for NSM.
保留乳头的乳房切除术（NSM）对于精心挑选的病例是一种有效的选择。尚未建立肿瘤学指南，但肿瘤与乳头的距离、肿瘤大小、淋巴结受累情况以及新辅助化疗已被提议作为保留乳头的禁忌证。本研究描述了我们在NSM方面与这些因素相关的经验，特别是肿瘤与乳头的距离，以帮助建立基于证据的NSM指南。
回顾了2014年至2018年在我们机构进行的所有NSM手术。使用乳腺X线摄影、超声或磁共振成像测量每位患者的肿瘤与乳头距离。所有患者在手术期间均接受乳头基部的冰冻切片（FS）活检，如果检测到癌症，则将手术转换为保留皮肤的乳房切除术。对患者进行术后并发症和癌症复发的随访。
68例患者（98个乳房）接受了NSM并立即进行了重建。53例患者（78%）因乳腺癌接受了该手术。1例患者在FS时检测到乳头受累，1例患者在FS阴性后永久病理检查时检测到乳头受累。我们43%的患者肿瘤与乳头距离≤2 cm。在平均32.5个月（±19.4个月）的随访期间，未观察到局部区域复发；然而，3例患者发生了远处转移。
当乳头基部的组织学检查为阴性（通过FS或永久病理检查）时，NSM在肿瘤学上可被认为是安全的。术前临床和影像学评估以及术中FS未发现乳头受累足以将患者分类为适合NSM。
