Kissin M W, Kark A E
Br J Surg. 1987 Jan;74(1):58-61. doi: 10.1002/bjs.1800740118.
In a retrospective study of 100 patients with operable breast cancer, microscopic involvement of the nipple-areola complex was found in 16 cases. Each of these 16 cases occurred in patients with centrally situated tumours. In contrast, nipple involvement did not occur with peripherally situated tumours lying greater than 2 cm outside the areolar margin (P less than 10(-6), Fisher's exact test). Nipple involvement was more likely in patients with greater than or equal to 4 positive axillary nodes (P less than 0.01, chi 2 test). From this study it appears that nipple preservation may be undertaken during mastectomy for small peripheral tumours, provided the nipple is clinically normal, and frozen section analysis of the sub-nipple area is shown to be free from tumour invasion. These criteria for nipple preservation were satisfied in 20 patients out of a prospective series of 60. In this group, nipple preservation on the skin flap improved the cosmetic result of breast reconstruction in 35 per cent, and facilitated skin closure in 20 per cent. After a mean follow-up period of 50.4 months, nipple preservation was not associated with any significant excess of local recurrences.
在一项对100例可手术乳腺癌患者的回顾性研究中，发现16例患者的乳头乳晕复合体有微小浸润。这16例中的每一例均发生在肿瘤位于中央的患者中。相比之下，乳晕边缘外大于2 cm的周围性肿瘤未出现乳头受累情况（P小于10^(-6)，Fisher精确检验）。腋窝淋巴结阳性数大于或等于4个的患者更易出现乳头受累（P小于0.01，卡方检验）。从这项研究来看，对于小的周围性肿瘤，在乳房切除术中如果乳头临床正常且乳头下区域的冰冻切片分析显示无肿瘤侵犯，那么可以保留乳头。在60例前瞻性研究系列中的20例患者满足这些乳头保留标准。在这组患者中，皮瓣上保留乳头使35%的乳房重建美容效果得到改善，20%的患者便于皮肤缝合。平均随访50.4个月后，保留乳头与任何明显的局部复发增多无关。
