Open AccessPathological Evaluation of Nipple‐Sparing Mastectomies with Emphasis on Occult Nipple Involvement: The Weill‐Cornell Experience with 325 Cases
Author(s) -
Eisenberg Rachel E.K.,
Chan Joanna S.Y.,
Swistel Alexander J.,
Hoda Syed A.
Publication year - 2014
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12199
Subject(s) - medicine , nipple discharge , malignancy , mastectomy , frozen section procedure , surgical margin , pathological , surgery , resection margin , stage (stratigraphy) , carcinoma , occult , prophylactic mastectomy , breast cancer , cancer , resection , mammography , pathology , paleontology , alternative medicine , biology
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 2 ≤ 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 2 ≤ 0.05).