Zhang K T, Guan S, Zhang B, Wang Y, Yue C S, Cheng R
Breast Center, Beijing Tongren Hospital Capital Medical University, Beijing 100176, China.
Zhonghua Zhong Liu Za Zhi. 2022 Jul 23;44(7):761-766. doi: 10.3760/cma.j.cn112152-20220408-00231.
To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. (2) test or Fisher exact test was used to analyze the influencing factors. Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (=0.040) and nipple invagination (=0.031). There were no correlations between tumor size (=0.519), lymph node metastasis (=0.847), bloody nipple discharge (=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.
探讨中央型乳腺癌乳头乳晕复合体（NAC）的手术处理策略。对2017年12月至2020年12月在首都医科大学附属北京同仁医院乳腺中心接受手术治疗的164例中央型乳腺癌患者进行回顾性分析。术前通过磁共振成像（MRI）测量肿瘤-乳头距离（TND）和肿瘤最大直径。相应记录乳头凹陷、乳头溢液和乳头溃疡（包括乳头派杰病）的情况。TND≥0.5 cm、无NAC侵犯征象（乳头凹陷、乳头溃疡）且术中冰冻病理切缘阴性的患者保留NAC。所有有NAC受累征象、TND<0.5 cm或术中冰冻病理证实NAC基底切缘阳性的患者均行NAC切除。（2）采用检验或Fisher确切检验分析影响因素。164例中央型乳腺癌患者中，73例行保乳手术，43例行保留乳头乳晕复合体的乳房切除术（NSM），34例行全乳房切除术，其余14例行保留皮肤的乳房切除术（SSM）。在58例NAC切除病例（包括34例全乳房切除术、14例SSM和10例保乳手术）中，25例确诊肿瘤累及NAC（全乳房切除术12例，SSM 9例，保乳手术4例）。NAC受累的相关因素包括TND（=0.040）和乳头凹陷（=0.031）。肿瘤大小（=0.519）、淋巴结转移（=0.847）、血性乳头溢液（=0.742）与NAC受累无相关性。在12至48个月的随访期内，有1例局部复发和3例远处转移。对于中央型乳腺癌，数据表明，TND≥0.5cm、无NAC侵犯征象（乳头凹陷、乳头溃疡）且术中冰冻病理NAC切缘阴性的患者应行保留NAC的手术，而TND<0.5 cm或伴有NAC侵犯征象的患者应切除NAC。此外，可选择乳头重建以进一步改善中央型乳腺癌患者的术后外观。
