Tumor-to-nipple distance should not preclude nipple-sparing mastectomy in breast cancer patients personal experience and literature review

Piero Fregatti, Marco Gipponi, Gabriele Zoppoli, Matteo Lambertini, Eva Blondeaux, Liliana Belgioia, Raffaele Derosa, Federica Murelli, Francesca Depaoli, Marcello Ceppi, Alessandro Garlaschi, Daniele Friedman

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aim: A retrospective study was performed in 246 breast cancer patients to define whether tumor-to-nipple distance (TND) assessment by breast MRI may select patients eligible to nipple-sparing mastectomy (NSM) as compared to permanent section assessment of retroareolar margin. Patients and Methods: Pre- and postoperative parameters including imaging data, histology of the primary tumor, biologic prognostic factors, and adjuvant regimens were retrieved; patients with close/positive retroareolar margins underwent nipple or NAC excision. The primary endpoint was loco-regional recurrence (LRR). Results: Patients with TND ≤2 cm had a significantly higher rate of invasive ductal carcinoma (p<0.003) and excision margins less than 2 mm (p<0.000). Eleven retroareolar specimens were positive at definitive pathology; final reexcision specimen examination showed residual disease in seven patients (63.6%). At a median follow-up of 31 to 33 months, no NAC recurrence did occur; disease-free survival was more than 96%, and LRR was homogeneously distributed among TND subgroups. Conclusion: Therapeutic NSM is a safe procedure independently of TND assessed at preoperative breast MRI. Permanent section assessment of retroareolar tissue is more accurate and cost-effective than frozen section. Furthermore, delayed nipple and/or NAC excision did not impair local disease control.

Original languageEnglish
Pages (from-to)3543-3550
Number of pages8
JournalAnticancer Research
Volume40
Issue number6
DOIs
Publication statusPublished - Jun 1 2020

Keywords

  • Breast cancer
  • Breast MRI
  • Nipple-sparing mastectomy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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