Intraoperative central nipple biopsy in nipple-sparing mastectomy- A retrospective analysis of 211 patients.
breast cancer
mastectomy
nipple biopsy
subcutaneous
Journal
The breast journal
ISSN: 1524-4741
Titre abrégé: Breast J
Pays: United States
ID NLM: 9505539
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
01
02
2021
received:
11
12
2020
accepted:
01
02
2021
pubmed:
24
2
2021
medline:
9
7
2021
entrez:
23
2
2021
Statut:
ppublish
Résumé
Subcutaneous nipple sparing mastectomies (NSM) are an important tool in modern oncoplastic surgery. Especially when an immediate implant-based reconstruction (IBR) is desired, clean margins are of the utmost importance. Central nipple biopsies during surgery serve two main purposes. Most importantly, it is hypothesized that intraoperative pathological evaluation of this biopsy may increase clean margin resection rates. In addition, a general recurrence risk reduction may occur due to the elimination of glandular and ductal components within the nipple. This analysis is a single center, multi-surgeon, retrospective, head to head analysis. Starting in March 2015, intraoperative central nipple biopsy in NSMs with IBR was introduced at the Municipal Breast Cancer Centre Cologne, Holweide, Germany. This trial retrospectively evaluates global complication rates, clean margin status and local recurrence rates for cohort 1 (NSM/no nipple biopsy, n = 103) vs. cohort 2 (NSM with nipple biopsy, n = 108) Median follow-up was 15 months. All implant-based reconstruction procedures used an epipectoral implant pocket. Cohorts were comparable. Global complication rates slightly favored the nipple biopsy cohort with respects to implant loss rate. An involved central nipple biopsy was found in 4.6% (n = 5/108) of the performed NSM procedures leading to the immediate removal of the nipple areola complex. All positive retro-areolar biopsies correlated with a positive nipple biopsy. However, in n = 1 case we found DCIS discontinual proliferation with an involved nipple biopsy, without a correlating positive retro-areolar biopsy (ie, 1 false-negative case was prevented). For the 15 month follow-up, there was no case of local recurrence within nipple areola complex for both cohorts. With this retrospective head to head analysis of 211 patients, it was shown that the central nipple biopsy correlates well with the retro-areolar biopsy. There may be a reduction in false negative rates. The procedure is safe to use and should be offered to NSM patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
363-368Informations de copyright
© 2021 The Authors. The Breast Journal published by Wiley Periodicals LLC.
Références
Mallon P, Feron J-G, Couturaud B, et al. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg. 2013;131(5):969-984.
Tokin C, Weiss A, Wang-Rodriguez J, Blair SL. Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol. 2012;2012:921821.
Frey JD, Alperovich M, Kim JC, et al. Oncologic outcomes after nipple-sparing mastectomy: a single-institution experience. J Surg Oncol. 2016;113(1):8-11.
Moo TA, Pinchinat T, Mays S, et al. Oncologic outcomes after nipple-sparing mastectomy. Ann Surg Oncol. 2016;23(10):3221-3225.
Colwell AS. Discussion: comparing therapeutic versus prophylactic nipple-sparing mastectomy: does indication inform oncologic and reconstructive outcomes? Plast Reconstr Surg. 2018;142(2):316-317.
Frey JD, Salibian AA, Karp NS, Choi M. Comparing therapeutic versus prophylactic nipple-sparing mastectomy: does indication inform oncologic and reconstructive outcomes? Plast Reconstr Surg. 2018;142(2):306-315.
Romanoff A, Zabor EC, Stempel M, Sacchini V, Pusic A, Morrow M, et al. A comparison of patient-reported outcomes after nipple-sparing mastectomy and conventional mastectomy with reconstruction. Ann Surg Oncol. 2018;25(10):2909-2916.
Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, Veronesi P, et al. Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast. 2017;34(Suppl 1):S82-S84.
Zheng Y, Zhong M, Ni C, Yuan H, Zhang J. Radiotherapy and nipple-areolar complex necrosis after nipple-sparing mastectomy: a systematic review and meta-analysis. Radiol Med. 2017;122(3):171-178.
Heidemann LN, Gunnarsson GL, Salzberg CA, Sørensen JA, Thomsen JB. Complications following nipple-sparing mastectomy and immediate acellular dermal matrix implant-based breast reconstruction-a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2018;6(1):e1625.
Frey JD, Salibian AA, Lee J, et al. Oncologic trends, outcomes, and risk factors for locoregional recurrence: an analysis of tumor-to-nipple distance and critical factors in therapeutic nipple-sparing mastectomy. Plast Reconstr Surg. 2019;143(6):1575-1585.
De La Cruz L, Moody AM, Tappy EE, Blankenship SA, Hecht EM. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Ann Surg Oncol. 2015;22(10):3241-3249.
Thangarajah F, Treeter T, Krug B, et al. Comparison of subpectoral versus prepectoral immediate implant reconstruction after skin- and nipple-sparing mastectomy in breast cancer patients: a retrospective hospital-based cohort study. Breast Care (Basel). 2019;14(6):382-387.
Eichler C, Schulz C, Thangarajah F, Malter W, Warm M, Brunnert K. A retrospective head-to-head comparison between TiLoop Bra/TiMesh(R) and Seragyn(R) in 320 cases of reconstructive breast surgery. Anticancer Res. 2019;39(5):2599-2605.
Eichler C, Efremova J, Brunnert K, et al. A head to head comparison between SurgiMend(R) - fetal bovine acellular dermal matrix and Tutomesh(R) - a bovine pericardium collagen membrane in breast reconstruction in 45 cases. Vivo. 2017;31(4):677-682.
Eichler C, Vogt N, Brunnert K, et al. A head-to-head comparison between SurgiMend and Epiflex in 127 breast reconstructions. Plast Reconstr Surg Glob Open. 2015;3(6):e439.
Pan L, Ye C, Chen L, et al. Oncologic outcomes and radiation safety of nipple-sparing mastectomy with intraoperative radiotherapy for breast cancer. Breast Cancer. 2019;26(5):618-627.
Schaverien MV. Discussion: oncologic trends, outcomes, and risk factors for locoregional recurrence: an analysis of tumor-to-nipple distance and critical factors in therapeutic nipple-sparing mastectomy. Plast Reconstr Surg. 2019;143(6):1586-1587.