Moo Tracy-Ann, Saccarelli Carolina Rossi, Sutton Elizabeth J, Sevilimedu Varadan, Pawloski Kate R, D'Alfonso Timothy M, Hughes Mary C, Gluskin Jill S, Bitencourt Almir, Morris Elizabeth A, Tadros Audree, Morrow Monica, Gemignani Mary L, Sacchini Virgilio
Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2021 Oct;28(11):6024-6029. doi: 10.1245/s10434-021-09902-2. Epub 2021 Apr 17.
As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS-) in women undergoing total mastectomy after NAC.
Women with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS- was examined and the accuracy of 1 cm TND on imaging for predicting NS- was determined.
Among 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement (p < 0.05). The likelihood of NS- was higher with increasing TND on pre- and post-NAC imaging (p < 0.05). TND ≥ 1 cm predicted NS- in 97% and 95% of breasts on pre- and post-NAC imaging, respectively.
Increasing TND was associated with a higher likelihood of NS-. A TND ≥ 1 cm on pre- or post-NAC imaging is highly predictive of NS- and could be used to determine eligibility for nipple-sparing mastectomy after NAC.
随着乳腺癌新辅助化疗（NAC）的应用日益广泛，保留乳头的乳房切除术也越来越普遍。一个常见的入选标准是肿瘤与乳头距离（TND）为1厘米，但NAC后该标准是否适用尚不清楚。在本研究中，我们调查了接受NAC后全乳房切除术的女性乳头病理状态为阴性（NS-）的预测因素。
回顾性纳入2014年8月至2018年4月在我院接受NAC及全乳房切除术的浸润性乳腺癌女性患者。在复查NAC前后的磁共振成像（MRI）和乳房X线照片后，研究临床病理和影像变量与NS-的相关性，并确定影像学上1厘米TND对预测NS-的准确性。
175例接受179次乳房切除术的女性中，NAC前分期74%的肿瘤为cT1-T2期，67%为cN+；最终病理检查发现10%（18/179）的乳头有浸润性癌或原位癌。多变量分析显示，在调整年龄、分级和肿瘤分期后，阳性淋巴结数目、NAC前乳头乳晕复合体回缩和TND减小这三个因素是乳头受累的显著预测因素（p<0.05）。NAC前后影像学上TND增加，NS-的可能性更高（p<0.05）。NAC前和NAC后影像学上TND≥1厘米分别预测97%和95%的乳房NS-。
TND增加与NS-的可能性更高相关。NAC前后影像学上TND≥1厘米高度预测NS-，可用于确定NAC后保留乳头乳房切除术的入选资格。
