Positive Nipple Margins in Nipple-Sparing Mastectomy: Management of Nipples Containing Cancer or Atypia.

Breast atypia Breast reconstruction Nipple Nipple areola complex excision Nipple recurrence Nipple-sparing mastectomy Peri-areolar recurrence Positive nipple margin

Journal

Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840

Informations de publication

Date de publication:
01 May 2024
Historique:
received: 05 03 2024
accepted: 09 04 2024
medline: 1 5 2024
pubmed: 1 5 2024
entrez: 1 5 2024
Statut: aheadofprint

Résumé

Nipple-sparing mastectomy (NSM) is an oncologically safe approach for breast cancer treatment and prevention; however, there are little long-term data to guide management for patients whose nipple margins contain tumor or atypia. NSM patients with tumor or atypia in their nipple margin were identified from a prospectively maintained, single-institution database of consecutive NSMs. Patient and tumor characteristics, treatment, recurrence, and survival data were assessed. A total of 3158 NSMs were performed from June 2007 to August 2019. Nipple margins contained tumor in 117 (3.7%) NSMs and atypia only in 164 (5.2%) NSMs. Among 117 nipple margins that contained tumor, 34 (29%) margins contained invasive cancer, 80 (68%) contained ductal carcinoma in situ only, and 3 (3%) contained lymphatic vessel invasion only. Management included nipple-only excision in 67 (57%) breasts, nipple-areola complex excision in 35 (30%) breasts, and no excision in 15 (13%) breasts. Only 23 (24%) excised nipples contained residual tumor. At 67 months median follow-up, there were 2 (1.8%) recurrences in areolar or peri-areolar skin, both in patients with nipple-only excision. Among 164 nipple margins containing only atypia, 154 (94%) nipples were retained. At 60 months median follow-up, no patient with atypia alone had a nipple or areola recurrence. Nipple excision is effective management for nipple margins containing tumor. No intervention is required for nipple margins containing only atypia. Our results support broad eligibility for NSM with careful nipple margin assessment.

Sections du résumé

BACKGROUND BACKGROUND
Nipple-sparing mastectomy (NSM) is an oncologically safe approach for breast cancer treatment and prevention; however, there are little long-term data to guide management for patients whose nipple margins contain tumor or atypia.
METHODS METHODS
NSM patients with tumor or atypia in their nipple margin were identified from a prospectively maintained, single-institution database of consecutive NSMs. Patient and tumor characteristics, treatment, recurrence, and survival data were assessed.
RESULTS RESULTS
A total of 3158 NSMs were performed from June 2007 to August 2019. Nipple margins contained tumor in 117 (3.7%) NSMs and atypia only in 164 (5.2%) NSMs. Among 117 nipple margins that contained tumor, 34 (29%) margins contained invasive cancer, 80 (68%) contained ductal carcinoma in situ only, and 3 (3%) contained lymphatic vessel invasion only. Management included nipple-only excision in 67 (57%) breasts, nipple-areola complex excision in 35 (30%) breasts, and no excision in 15 (13%) breasts. Only 23 (24%) excised nipples contained residual tumor. At 67 months median follow-up, there were 2 (1.8%) recurrences in areolar or peri-areolar skin, both in patients with nipple-only excision. Among 164 nipple margins containing only atypia, 154 (94%) nipples were retained. At 60 months median follow-up, no patient with atypia alone had a nipple or areola recurrence.
CONCLUSIONS CONCLUSIONS
Nipple excision is effective management for nipple margins containing tumor. No intervention is required for nipple margins containing only atypia. Our results support broad eligibility for NSM with careful nipple margin assessment.

Identifiants

DOI: 10.1245/s10434-024-15362-1 PMID: 38691238
pubmed: 38691238
doi: 10.1245/s10434-024-15362-1
pii: 10.1245/s10434-024-15362-1
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. Society of Surgical Oncology.

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Auteurs

Julia N Shanno (JN)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Abigail E Daly (AE)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Kyle J Anderman (KJ)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Heidi S Santa Cruz (HS)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Alexandra J Webster (AJ)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Robert M Pride (RM)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Michelle C Specht (MC)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Michele A Gadd (MA)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Tawakalitu O Oseni (TO)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Francys C Verdial (FC)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Tolga Ozmen (T)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Rebecca Kwait (R)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.

Amy S Colwell (AS)

Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA.

Barbara L Smith (BL)

Breast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA. blsmith1@mgh.harvard.edu.

Classifications MeSH