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A Comparison of Clinical and Pathologic Assessments for the Prediction of Occult Nipple Involvement in Nipple-Sparing Mastectomies

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nipple-sparing mastectomy (NSM) for both risk reduction and cancer is increasing. In the cancer setting, most studies suggest the use of both clinical and intraoperative biopsy criteria in patient selection. This study examines the use of both biopsy and clinical criteria in women undergoing total nipple-removing mastectomy.

Methods

The study consisted of 58 patients undergoing total mastectomy without nipple sparing. Biopsies of the subareola tissue (SA), proximal nipple (NC) contents and radial sections of the residual nipple (NR) were examined microscopically. Tumor size and distance from the nipple were also noted.

Results

Using clinical criteria alone, the false negative rate was 53.8 % and a false positive rate of 44.4 %. When adding subareola and nipple core biopsies to clinical criteria the false negative rate fell to 7.7 % but the false positive rate remained at 44.4 %. When using only SA and NC biopsies to predict occult nipple involvement, the false negative rate was 11.8 %. In 4 cases the NC was positive while the SA was negative for cancer and in 6 cases the SA was positive and NC negative. In 2 cases both the NC and SA biopsies were negative while the NR was positive.

Conclusions

This study supports a more limited role in the use of clinical criteria for evaluating patients for NSM. This maximizes the number of patients who are candidates for NSM with minimal risk of nipple involvement. It was also noted that intraoperative biopsies are not totally reliable in predicting occult nipple involvement.

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Disclosure

The authors have no commercial interests to disclose.

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Authors and Affiliations

  1. Department of Surgery, Tulane University Medical Center, 1717 St. Charles Ave, New Orleans, LA, USA

    Alan Stolier MD & Steven D. Jones MD

  2. Department of Pathology, Tulane University Medical Center, New Orleans, LA, USA

    Jonathan C. Stone MD & Krzysztof Moroz MD

  3. Department of Radiology, Tulane University Medical Center, New Orleans, LA, USA

    Cynthia W. Hanemann MD & Leslee McNabb MD

  4. Department of Mathematics, Tulane University, New Orleans, LA, USA

    Michelle Lacey PhD

Authors
  1. Alan Stolier MD
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  2. Jonathan C. Stone MD
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  3. Krzysztof Moroz MD
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  4. Cynthia W. Hanemann MD
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  5. Leslee McNabb MD
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  6. Steven D. Jones MD
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  7. Michelle Lacey PhD
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Correspondence to Alan Stolier MD.

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Stolier, A., Stone, J.C., Moroz, K. et al. A Comparison of Clinical and Pathologic Assessments for the Prediction of Occult Nipple Involvement in Nipple-Sparing Mastectomies. Ann Surg Oncol 20, 128–132 (2013). https://doi.org/10.1245/s10434-012-2511-3

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  • DOI: https://doi.org/10.1245/s10434-012-2511-3

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