The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients

Isabella Castellano, Jasna Metovic, Davide Balmativola, Laura Annaratone, Nelson Rangel, Elena Vissio, Riccardo Arisio, Luigia Macrì, Carla Pecchioni, Ivana Sarotto, Francesca Montarolo, Francesca Muscarà, Caterina Marchiò, Paola Cassoni, Janina Kulka, Anna Sapino

Research output: Contribution to journalArticle

Abstract

Background: The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. Methods: We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. Results: Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, χ251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, χ211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues. Conclusions: Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases.

Original languageEnglish
Article numbere0182073
JournalPLoS One
Volume12
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

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Cytology
Nipples
cell biology
breast neoplasms
Cell Biology
Breast Neoplasms
Surgery
immunocytochemistry
surgery
carcinoma
Carcinoma, Intraductal, Noninfiltrating
amputation
Immunohistochemistry
Amputation
Nipple Discharge
Mastectomy

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients. / Castellano, Isabella; Metovic, Jasna; Balmativola, Davide; Annaratone, Laura; Rangel, Nelson; Vissio, Elena; Arisio, Riccardo; Macrì, Luigia; Pecchioni, Carla; Sarotto, Ivana; Montarolo, Francesca; Muscarà, Francesca; Marchiò, Caterina; Cassoni, Paola; Kulka, Janina; Sapino, Anna.

In: PLoS One, Vol. 12, No. 8, e0182073, 01.08.2017.

Research output: Contribution to journalArticle

Castellano, I, Metovic, J, Balmativola, D, Annaratone, L, Rangel, N, Vissio, E, Arisio, R, Macrì, L, Pecchioni, C, Sarotto, I, Montarolo, F, Muscarà, F, Marchiò, C, Cassoni, P, Kulka, J & Sapino, A 2017, 'The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients', PLoS One, vol. 12, no. 8, e0182073. https://doi.org/10.1371/journal.pone.0182073
Castellano, Isabella ; Metovic, Jasna ; Balmativola, Davide ; Annaratone, Laura ; Rangel, Nelson ; Vissio, Elena ; Arisio, Riccardo ; Macrì, Luigia ; Pecchioni, Carla ; Sarotto, Ivana ; Montarolo, Francesca ; Muscarà, Francesca ; Marchiò, Caterina ; Cassoni, Paola ; Kulka, Janina ; Sapino, Anna. / The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients. In: PLoS One. 2017 ; Vol. 12, No. 8.
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abstract = "Background: The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. Methods: We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. Results: Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58{\%}). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, χ251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, χ211.98). HER2 immunocytochemistry on the NDc revealed a 100{\%} correlation with the immunocytochemistry performed on the surgical tissues. Conclusions: Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases.",
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T1 - The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients

AU - Castellano, Isabella

AU - Metovic, Jasna

AU - Balmativola, Davide

AU - Annaratone, Laura

AU - Rangel, Nelson

AU - Vissio, Elena

AU - Arisio, Riccardo

AU - Macrì, Luigia

AU - Pecchioni, Carla

AU - Sarotto, Ivana

AU - Montarolo, Francesca

AU - Muscarà, Francesca

AU - Marchiò, Caterina

AU - Cassoni, Paola

AU - Kulka, Janina

AU - Sapino, Anna

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. Methods: We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. Results: Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, χ251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, χ211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues. Conclusions: Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases.

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