Prediction of Nipple Areolar Complex Involvement in Breast Cancer

Authors

  • Visnu Lohsiriwat Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Supakorn Rojananin Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Kris Bhothisuwan Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Adune Ratanawichitrasin Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Pornchai O-charoenrat Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Seubwong Jutaphisit Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Poramaporn Prasarttong-Osoth Division of Head-Neck and Breast, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Parvinee Suwanagoon Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Teinjai Chuangsuwanij Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

Abstract

Background: The role of nipple sparing mastectomy as an alternative to standard mastectomy is becoming available. Due to the varied reported incidence of nipple-areolar complex (NAC) involvement (6-54%) in breast cancer with no reliable preoperative clinico-pathological predictors, the patient selection for nipple sparing mastectomy is challenging.

This study aimed to determine the incidence of NAC involvement in 'Thai breast cancer patients with clinically-uninvolved nipples. The predictive value of frozen section of subnipple tissue and other clinico-pathological parameters in determining NAC involvement were systematically examined.

Research Design: Prospective descriptive analysis in a tertiary care hospital

Materials and Methods: Patient selection: All breast cancer patients who underwent standard mastectomy were included, excluding those who had clinically nipple involvement, neoadjuvant chemotherapy, Paget's disease and pre-excisional biopsy.

Study Procedure: From mastectomy specimen the subnipple tissue was collected for frozen section to compare with serial permanent section of NAC. The clinical data, mammographic or sonographic finding and pathological report were collected for analysis.

References

1. Kirby IB, Michael PV, Edward MB. Breast, In: Swartz SI, editor. Principle of Surgery. 7 ed. Philadelphia: WB Saunders; 1999. P. 533-600.

2. Ungsusing T. Screening mammography: when for Thai women?. In: Rojananin S, editor. Head neck and breast surgery. Vol 2, Bangkok: Reonkeow; 2000.

3. Petit J, Rietjens M, Garusi C. Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks? Critical Reviews in Oncology-Hematology 2001: 38: 231-9.

4. Dale PS, Giuliano AE. Nipple-areolar preservation during breast-conserving therapy for subareolar breast carcinomas. Arch Surg 1996;131: 430-3.

5. Kissin MW, Kark AE. Nipple preservation during mastectomy. Br J Surg 1987;74: 58-61.

6. Toth BA, Forley BG, Calabria R, Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 1999; 104: 77-84.

7. Simmons RM, Brennan M, Christos P, King V, Osborne M. Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol 2002:9: 165-8.

8. Haagensen CD, Lymphatics of the breast, In: Haagensen CD, editor. The Lymphatics cancer. Philadelphia: WB Saunders; 1972.

9. Nahabedian, Maurice Y, Mehrdad M. Viability and sensation of the Nipple-Areolar complex after reduction mammoplasty. Ann Plast Surg 2002: 49: 24-32.

10. Casas LA, Byun MY, Depoli PA, Maximizing breast projection after Free-Nipple-Graft reduction mammoplasty. Plast Reconstruct Surg 2001: 107: 955-60.

11. Vyas JJ, Chinoy RF, Vaidya JS. Prediction of nipple and areolar involvement in breast cancer. Eur J Surg Oncol 1998; 24: 15-6.

12. Santini D, Taffurelli M, Gelli MC, Grassigli A, Giosa F, Marrano D, et al. Neoplastic involvement of nipple-areolar complex in invasive breast cancer. Am J Surg 1989: 158: 399-403.

13. Klimberg VS, Westbrook KC, Korourian S, Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol 1998: 5: 220-6.

14. Ikeda T, Enomoto K, Wada K, Takeshima K, Yoneyama K. Furukawa J, et al. Frozen-section-guided breast-conserving surgery: implications of diagnosis by frozen section as a guide to determining the extent of resection. Surgery Today 1997;27:207-12,

15. Thamthalerngkit S. Surgical pathology and frozen section in breast cancer. In: Rojananin S, editor. Head neck and breast surgery. Vol 1. Bangkok; Reonkeow; 1995.

16. Crowe, Joseph PJ, Kim et al. Nipple-sparing mastectomy: technique and results of 54 procedures. Arch of Surg 2004; 139: 148-50.

17. Tavassoli FA. A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast, Cancer1990; 65:518-29.

18. Page DL, Dupont WD, Rogers LW, et al. Atypical hyperplastic lesions of the female breast: a long-term follow-up study Cancer 1985; 55: 2698-708.

19. Jeffrey SS. The diagnosis and management of pre-invasive breast disease: promise of new technologies in understanding pre-invasive breast lesions. Breast Cancer Re 2003;5:320-8.

20. Suehiro S, Inai K, Tokuoka S, et al. Involvement of the nipple in early carcinoma of the breast. Surg Gynecol Obstet 1986 168:244-8.

21. Cense HA. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 2001; 27: 521-6.

22. Cense HA, Rutgers EJ, Lopes CM et al. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 2001; 27: 521-6.

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Published

2004-09-30

How to Cite

1.
Lohsiriwat V, Rojananin S, Bhothisuwan K, Ratanawichitrasin A, O-charoenrat P, Jutaphisit S, Prasarttong-Osoth P, Suwanagoon P, Chuangsuwanij T. Prediction of Nipple Areolar Complex Involvement in Breast Cancer. Thai J Surg [Internet]. 2004 Sep. 30 [cited 2024 May 4];25(3):71-8. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/242293

Issue

Vol. 25 No. 3 (2004): July - September

Section

Original Articles

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Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.