Nipple-Sparing Mastectomy: Reliability of sub-areolar sampling and frozen section in predicting occult nipple involvement in breast cancer patients

D’Alonzo, Marta; Pecchio, Silvia; Campisi, Paola; Rosa, G.; Bounous, Valentina Elisabetta; Villasco, Andrea; Balocco, Paolo; Biglia, Nicoletta

doi:10.1016/j.ejso.2018.07.059

Cited by 15 publications

(5 citation statements)

References 17 publications

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“…25 Other controversial issues concern intraoperative margin assessment and the need for NAC resection if disease-positive. 24,[28][29][30][31] In the present study, frozen section examination was not routinely performed, with decisions regarding management being based on the final histological analysis of the surgical specimen. Initially, the possibility of a false-positive result is a motive of concern, particularly in low-grade lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Initially, the possibility of a false-positive result is a motive of concern, particularly in low-grade lesions. 29 Furthermore, identification of disease at frozen section examination does not necessarily mean recurrence in the NAC. Analysis of 948 NSM and 88 false-negatives at frozen section examination showed that the 5-year accumulated rate of local recurrence in the NAC was 2.4%, suggesting that it is possible to preserve the NAC in selected cases following an interdisciplinary debate and discussion with the patient.…”

Section: Discussionmentioning

confidence: 99%

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Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

Cavalcante

Araújo

Veras

et al. 2022

Rev Bras Ginecol Obstet

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Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

Cavalcante

Araújo

Veras

et al. 2022

Rev Bras Ginecol Obstet

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“…According to the recommendation of latest NCCN guidelines(2020.v3), the nipple-areolar complex (NAC) could be preserved in cancer patients selected by experienced multidisciplinary teams.Paget's disease, nipple discharge associated with cancer,and imaging evidence of the nipple or subareolar tissues involvement should be excluded,and nipple margin assessment is de nitely needed.However,the standard assessment of NSM candidates and indications are still unde ned and inconsistent.In our study,frozen section examination of nipple margin(retro-areolar tissue) were conducted in all NSM cases,whose results were all consistent to permanent para n sections.One patient sacri ced the NAC due to a positive nipple margin in NSM,but the removed NAC turned out no cancer involved.Smith et al used frozen sections rarely in the procedure of NSM,because they deemed that frozen section was less accurate than permanent pathologic examination,and has di culty in distinguishing benign atypia from ductal carcinoma in situ (DCIS) [21].In a study by D'Alonzo, a discoid specimen beneath the base of the nipple was obtained as nipple margin.They found that the sub-areolar/nipple tissue assessment had a sensitivity of 42.3% in predicting nipple involvement.Though the frozen sections showed a great concordance(92.1%) with nal para n-embedded sections,it should be careful to remove the NAC when DCIS was diagnosed in the frozen section examination [23]. Additionally, Ponzone suggested to perform double intra-operative assessment of subareolar ducts and proximal nipple ducts,to increase the sensitivity of intraoperative pathological assessment [24].…”

Section: Discussionmentioning

confidence: 99%

The Associated Clinicopathologic Characteristics of Nipple-Areola Complex Involvement in Breast Cancer

Huang¹,

Huang²,

Jiang³

et al. 2021

Preprint

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Background. At present,the indication for nipple-sparing mastectomy（NSM）remains inconclusive,and the occult NAC involvement （NI）is one of the most considerable problem when carrying out NSM.We aimed at identifying the predictive factors of NAC involvement,to provide an implement of selecting suitable NSM candidates.Methods. The association between the NI and tumorous clinicopathologic characteristics of 272 mastectomies and 31 therapeutic NSM performed in our hospital from 2016 to 2018，were retrospectively evaluated.Results.38 of 272（14.0%）mastectomies and 2 of 31（6.5%）NSM were confirmed to have NAC involvement, and all the intraoperative frozen section examination of the sub-areolar/nipple tissue were consistent with the permanent section examination in NSM. The median follow-up durations for NSM was 24 months,local recurrence occurred in 1 of 30（3.2%） patients.Among 272 mastectomies，the NAC involvement showed significant association with the abnormal nipple signs（P＜0.001），tumor size ＞4cm measured by ultrasound （P＜0.001）and gross pathologic samples（P＜0.001），tumor-nipple distance ＜1cm（P=0.003），central location（P＜0.001），lymph node metastasis（P=0.004），and HER2 overexpression（P=0.023）.A preoperative predictive model of NAC involvement utilizing nipple signs(normal or abnormal),tumor size(≤4cm or ＞4cm),tumor location(central or peripheral) showed a PPV of 85.7% and a NPV of 90.3%.Conclusions.The local recurrence rate after NSM is low （3.2%）in our study，and the intraoperative frozen section examination plays an important role in the procedure of NSM.Further more，we proposed a predictive model of the NAC involvement utilizing the preoperative tumorous characteristics，including the nipple signs，tumor size measured by ultrasound，and the tumor location.This predictive model could be working in the planning of breast cancer surgery.

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“…24 A recent study represented that intraoperative frozen section examination of the subareolar margin was accurate to predict nipple invasion because the false-negative rate was less than 5%. 25 Therefore, NSM together with intraoperative frozen examination could be considered when NME does not extend to the nipple on breast MRI.…”

Section: Discussionmentioning

confidence: 99%

Significance of Non-Mass Enhancement in the Subareolar Region on Preoperative Breast Magnetic Resonance Imaging for Nipple-Sparing Mastectomy

Jun

Bae

Jin

et al. 2020

Clinical Breast Cancer

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The eligibility for NSM regarding to subareolar NME on breast MRI was not clear. The rate of pathologic nipple invasion was as low as 6.1% when NME did not extend to the nipple on breast MRI. NSM is possible if NME does not involve the nipple on breast MRI. Purpose: The eligibility for nipple-sparing mastectomy (NSM) regarding subareolar non-mass enhancement (NME) on breast magnetic resonance imaging (MRI) was not clear. This study aimed to evaluate the eligibility for NSM according to the NME-to-nipple distance on preoperative breast MRI. Methods: We identified patients with breast cancer who underwent mastectomy with NME suspected of malignancy in the subareolar region on preoperative breast MRI. The incidence of nipple invasion was pathologically evaluated according to the NME-to-nipple distance on breast MRI, and the clinicopathologic factors related to pathologic nipple invasion were analyzed. Results: Of 137 patients, 55 (40.1%) had NME extension to the nipple, 53 (38.7%) had radiologic distance less than 2 cm, and 29 (21.2%) had radiologic distance of 2 cm or more. The rate of pathologic nipple invasion was 52.7% (29 of 55) in patients with NME extension to nipple, 7.5% (4 of 53) in patients with NME-to-nipple distance less than 2 cm, and 3.4% (1 of 29) in patients with NME-to-nipple distance of 2 cm or more (P < .001). NME extension to the nipple was an independent risk factor for pathologic nipple invasion (odds ratio 21.702; 95% confidence interval, 2.613e180.225; P ¼ .004). The survival outcome was not different between NSM and conventional total mastectomy/skin-sparing mastectomy in patients with radiologic distance less than 2 cm, but without NME extension to the nipple. Conclusions: NSM is an acceptable procedure in patients with breast cancer with a low incidence of pathologic nipple invasion when there is no evidence of NME extension to the nipple on preoperative breast MRI.

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Nipple-Sparing Mastectomy: Reliability of sub-areolar sampling and frozen section in predicting occult nipple involvement in breast cancer patients

Cited by 15 publications

References 17 publications

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

The Associated Clinicopathologic Characteristics of Nipple-Areola Complex Involvement in Breast Cancer

Significance of Non-Mass Enhancement in the Subareolar Region on Preoperative Breast Magnetic Resonance Imaging for Nipple-Sparing Mastectomy

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