Primary tumor location predicts the site of local relapse after nipple–areola complex (NAC) sparing mastectomy

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Abstract

Purpose: To assess the oncological safety of nipple–areola complex (NAC) sparing mastectomy in breast cancer patients. Methods: From 2010 to 2015, 518 breast cancer patients were submitted to NAC sparing mastectomy. Breast MRI and intraoperative assessment of the subareolar (SD) and proximal (ND) nipple ducts were performed to predict NAC involvement. Significant associations between pre- and postoperative variables with SD/ND involvement and with the risk of local recurrence were retrospectively investigated. Results: SD/ND were involved in 26.1% of the cases. Final pathology of SD/ND was predicted by tumor–NAC distance at MRI and intraoperative pathology with 75 and 93% accuracy, respectively. NAC involvement was more frequent in case of positive ND than positive SD (68.3 vs. 38.3%; p = 0.003). Fourteen (2.7%) local relapses developed over a mean follow-up of 33 months. Ki-67 ≥25% (p = 0.002) and high tumor grade (p = 0.027) correlated with local recurrence. Most relapses developed in the subcutaneous tissue of the quadrant where the primary tumor was located (12/14; 85.7%). No local relapses occurred in patients who received post-mastectomy radiotherapy as compared to patients who did not, although they had a higher rate of positive surgical margins (40.5 vs. 16.2%; p = 0.000). Conclusions: NAC involvement can be predicted by MRI and intraoperative pathology of ND/SD. Local recurrences after NAC sparing mastectomy almost invariably develop in the same quadrant where the primary tumor was located and in highly proliferative tumors.

Original languageEnglish
Pages (from-to)85-95
Number of pages11
JournalBreast Cancer Research and Treatment
Volume165
Issue number1
DOIs
Publication statusPublished - Aug 1 2017

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Mastectomy
Recurrence
Neoplasms
Pathology
Breast Neoplasms
Nipples
Subcutaneous Tissue
Breast
Radiotherapy
Safety

Keywords

  • Breast cancer
  • Local relapse
  • Mastectomy
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{a6c747fc31924b82834283ab2cefb76e,
title = "Primary tumor location predicts the site of local relapse after nipple–areola complex (NAC) sparing mastectomy",
abstract = "Purpose: To assess the oncological safety of nipple–areola complex (NAC) sparing mastectomy in breast cancer patients. Methods: From 2010 to 2015, 518 breast cancer patients were submitted to NAC sparing mastectomy. Breast MRI and intraoperative assessment of the subareolar (SD) and proximal (ND) nipple ducts were performed to predict NAC involvement. Significant associations between pre- and postoperative variables with SD/ND involvement and with the risk of local recurrence were retrospectively investigated. Results: SD/ND were involved in 26.1{\%} of the cases. Final pathology of SD/ND was predicted by tumor–NAC distance at MRI and intraoperative pathology with 75 and 93{\%} accuracy, respectively. NAC involvement was more frequent in case of positive ND than positive SD (68.3 vs. 38.3{\%}; p = 0.003). Fourteen (2.7{\%}) local relapses developed over a mean follow-up of 33 months. Ki-67 ≥25{\%} (p = 0.002) and high tumor grade (p = 0.027) correlated with local recurrence. Most relapses developed in the subcutaneous tissue of the quadrant where the primary tumor was located (12/14; 85.7{\%}). No local relapses occurred in patients who received post-mastectomy radiotherapy as compared to patients who did not, although they had a higher rate of positive surgical margins (40.5 vs. 16.2{\%}; p = 0.000). Conclusions: NAC involvement can be predicted by MRI and intraoperative pathology of ND/SD. Local recurrences after NAC sparing mastectomy almost invariably develop in the same quadrant where the primary tumor was located and in highly proliferative tumors.",
keywords = "Breast cancer, Local relapse, Mastectomy, Radiotherapy",
author = "Cont, {Nicoletta Tomasi} and Furio Maggiorotto and Laura Martincich and Alessandro Rivolin and Franziska Kubatzki and Paola Sgandurra and Francesco Marocco and Alessandra Magistris and Marco Gatti and Davide Balmativola and Filippo Montemurro and Anna Sapino and Riccardo Ponzone",
year = "2017",
month = "8",
day = "1",
doi = "10.1007/s10549-017-4312-7",
language = "English",
volume = "165",
pages = "85--95",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York LLC",
number = "1",

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TY - JOUR

T1 - Primary tumor location predicts the site of local relapse after nipple–areola complex (NAC) sparing mastectomy

AU - Cont, Nicoletta Tomasi

AU - Maggiorotto, Furio

AU - Martincich, Laura

AU - Rivolin, Alessandro

AU - Kubatzki, Franziska

AU - Sgandurra, Paola

AU - Marocco, Francesco

AU - Magistris, Alessandra

AU - Gatti, Marco

AU - Balmativola, Davide

AU - Montemurro, Filippo

AU - Sapino, Anna

AU - Ponzone, Riccardo

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Purpose: To assess the oncological safety of nipple–areola complex (NAC) sparing mastectomy in breast cancer patients. Methods: From 2010 to 2015, 518 breast cancer patients were submitted to NAC sparing mastectomy. Breast MRI and intraoperative assessment of the subareolar (SD) and proximal (ND) nipple ducts were performed to predict NAC involvement. Significant associations between pre- and postoperative variables with SD/ND involvement and with the risk of local recurrence were retrospectively investigated. Results: SD/ND were involved in 26.1% of the cases. Final pathology of SD/ND was predicted by tumor–NAC distance at MRI and intraoperative pathology with 75 and 93% accuracy, respectively. NAC involvement was more frequent in case of positive ND than positive SD (68.3 vs. 38.3%; p = 0.003). Fourteen (2.7%) local relapses developed over a mean follow-up of 33 months. Ki-67 ≥25% (p = 0.002) and high tumor grade (p = 0.027) correlated with local recurrence. Most relapses developed in the subcutaneous tissue of the quadrant where the primary tumor was located (12/14; 85.7%). No local relapses occurred in patients who received post-mastectomy radiotherapy as compared to patients who did not, although they had a higher rate of positive surgical margins (40.5 vs. 16.2%; p = 0.000). Conclusions: NAC involvement can be predicted by MRI and intraoperative pathology of ND/SD. Local recurrences after NAC sparing mastectomy almost invariably develop in the same quadrant where the primary tumor was located and in highly proliferative tumors.

AB - Purpose: To assess the oncological safety of nipple–areola complex (NAC) sparing mastectomy in breast cancer patients. Methods: From 2010 to 2015, 518 breast cancer patients were submitted to NAC sparing mastectomy. Breast MRI and intraoperative assessment of the subareolar (SD) and proximal (ND) nipple ducts were performed to predict NAC involvement. Significant associations between pre- and postoperative variables with SD/ND involvement and with the risk of local recurrence were retrospectively investigated. Results: SD/ND were involved in 26.1% of the cases. Final pathology of SD/ND was predicted by tumor–NAC distance at MRI and intraoperative pathology with 75 and 93% accuracy, respectively. NAC involvement was more frequent in case of positive ND than positive SD (68.3 vs. 38.3%; p = 0.003). Fourteen (2.7%) local relapses developed over a mean follow-up of 33 months. Ki-67 ≥25% (p = 0.002) and high tumor grade (p = 0.027) correlated with local recurrence. Most relapses developed in the subcutaneous tissue of the quadrant where the primary tumor was located (12/14; 85.7%). No local relapses occurred in patients who received post-mastectomy radiotherapy as compared to patients who did not, although they had a higher rate of positive surgical margins (40.5 vs. 16.2%; p = 0.000). Conclusions: NAC involvement can be predicted by MRI and intraoperative pathology of ND/SD. Local recurrences after NAC sparing mastectomy almost invariably develop in the same quadrant where the primary tumor was located and in highly proliferative tumors.

KW - Breast cancer

KW - Local relapse

KW - Mastectomy

KW - Radiotherapy

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U2 - 10.1007/s10549-017-4312-7

DO - 10.1007/s10549-017-4312-7

M3 - Article

AN - SCOPUS:85019706509

VL - 165

SP - 85

EP - 95

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

IS - 1

ER -