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Erschienen in:
01.10.2011 | American Society of Breast Surgeons
Preoperative Predictors of Nipple–Areola Complex Involvement for Patients Undergoing Mastectomy for Breast Cancer
Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2011
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Background
Proper patient selection is important for nipple-sparing mastectomy, and we aimed to identify preoperative factors predictive of pathologic nipple-areola complex (NAC) involvement to assist with surgical planning.
Methods
We retrospectively reviewed a prospectively collected database of patients who underwent mastectomy for DCIS or invasive breast cancer at a single institution. Cases with NAC involvement, NAC(+), were compared with those without NAC involvement, NAC(−). Multivariate logistic regression analysis was performed to determine preoperative factors independently predictive of NAC involvement.
Results
A total of 238 standard, 107 skin-sparing, and 47 nipple-sparing mastectomies were performed, and the NAC was pathologically involved in 16% (N = 62). Clinical NAC involvement, as determined by patient symptoms or physical exam, was present in 61% of NAC(+) but only 14% of NAC(−) cases (P < .0001) and carried a 92% negative predictive value (NPV). Preoperative imaging involved the NAC in 38% of NAC(+) but only 4% of NAC(−) cases (P < .0001) and carried an 89% NPV. NAC(+) tumors were larger, with mean size 3.3 cm versus 2.5 cm for NAC(−) tumors (P = .024). The mean tumor-to-nipple distance was 2.0 cm for NAC(+) versus 4.7 cm for NAC(−) tumors (P < .0001). On multivariate analysis, independent predictors of NAC involvement were the presence of clinical NAC involvement (odds ratio [OR] 5.11, 95% confidence interval [95% CI] 2.53–10.35) and imaging involvement of the NAC (OR 5.82, 95% CI 2.43–13.94).
Conclusions
Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.