Pathological Evaluation of Nipple‐Sparing Mastectomies with Emphasis on Occult Nipple Involvement: The Weill‐Cornell Experience with 325 Cases. Issue 1 (January 2014)

• Record Type: Journal Article
• Authors: Eisenberg, Rachel E.K.; Chan, Joanna S.Y.; Swistel, Alexander J.; Hoda, Syed A.
• Is Part Of: Breast journal. Volume 20:Issue 1(2014:Jan./Feb.)
• Page Start: 15
• Page End: 21
• Publication Date: 2014-01
• Subjects: Breast -- Diseases -- Periodicals; Breast -- Cancer -- Periodicals; 618.19
• DOI: 10.1111/tbj.12199
• Languages: English
• ISSNs: 1075-122X

Abstract

<abstract abstract-type="main" id="tbj12199-abs-0001"> <title>Abstract</title> <p>Nipple‐sparing mastectomy (NSM) is an increasingly utilized surgical option in managing breast carcinoma; however, data on malignant involvement of a separately submitted nipple margin are scant. Consecutive NSM, including those performed for therapeutic and prophylactic purposes, over a 4‐year period (2007–2011), were studied. A separately submitted nipple margin was evaluated by permanent H&E preparations and via frozen section evaluation whenever requested. 325 consecutive NSM specimens, 208 (64%) therapeutic‐NSM, and 117 (36%) prophylactic‐NSM were studied. All nipples were clinically unremarkable. 86% (179/208) of nipple margins from therapeutic‐NSM and 100% (117/117) from prophylactic‐NSM showed no histopathologic abnormality. 14% (29/208) of nipple margins from therapeutic‐NSM and no nipple margin from prophylactic‐NSM showed malignancy. Frozen section evaluation was performed in 188/325 NSM (58%) with a sensitivity of 64% and specificity of 99%. Central tumor location and stage N2/N3 lymph node status were significantly associated with nipple margin positivity (χ<sup>2</sup> ≤ 0.05). Subsequent nipple resection was performed in 69% (20/29) of nipple margin‐positive cases with residual malignancy found in 40% (8/20, including three cases of invasive carcinoma). In a mean follow‐up of 33 months, one invasive carcinoma recurred in the "saved" nipple, 36 months after therapeutic‐NSM. 14% (29/208) of nipple margins in therapeutic‐NSM and no nipple margin (0/117) in prophylactic‐NSM showed malignancy. Central tumor location and N2/N3 stage were significantly associated with nipple margin positivity (χ<sup>2</sup> ≤ 0.05).</p> </abstract>