Correlating preoperative clinicopathological factors with skin and/ or nipple–areola complex tumor involvement in postmastectomy specimens

Abstract

. ABSTRACT Background: Breast cancer is the most commonly diagnosed cancer in women. Breast-conserving surgery is a common standard for treating many breast cancer patients. However, MRM (Modified radical mastectomy) is still done in ⁓ 30 % of patients undergoing surgeries. Our goal of the study is to identify factors that predict histopathological retro-areolar ducts and skin lymphatics tumor involvement, as well as to formulate bases extending the indication of skin sparing, especially nipple–areola complex (NAC) sparing mastectomy. Patients and Methods: The study is an observational analytic study conducted on 145 cases. Inclusion criteria of the study are females sex, aged more than 18 years with locoregional breast disease who are candidates for MRM. Exclusion criteria are cases with grossly involved NAC, inflammatory breast cancer, skin ulceration, and nodules, Paget’s disease of the nipple, and candidates for conservative breast surgery. Preoperatively, all patients were subjected to a triple assessment of the breast cancer. Postoperatively, all mastectomy specimens are sent for the histopathological assessment. Results: By univariate analysis, factors significantly affecting skin and NAC tumor involvement were age, tumor size, multifocality, nodal metastasis, histological grade, localized skin edema (peau d’orange), and lymphovascular invasion. By multivariate analysis, factors significantly increasing skin and NAC tumor involvement were nodal metastasis, localized skin edema, unexposure to neoadjuvant chemotherapy, and HER2 neo positive cases. Conclusion: We can extend indications of SSM (Skin sparing mastectomy) in cases with negative nodal metastasis and absence of localized skin edema, who were exposed to neoadjuvant chemotherapy and HER2 neo negative cases.