Safety of Atypical Ductal Hyperplasia at the Nipple Margin in Nipple-Sparing Mastectomy.

IF 2.2 4区医学 Q3 ONCOLOGY Journal of Breast Cancer Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI:10.4048/jbc.2024.0077

Meizhen Zhu, Jiefei Mao, Jun Fang, Daobao Chen

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Abstract

Purpose: Controversies persist regarding contraindications for nipple-sparing mastectomy (NSM). This study aimed to assess the accuracy of subareolar frozen section analysis and identify risk factors for nipple-areola complex (NAC) recurrence post NSM.

Methods: Consecutive cases of primary invasive breast cancer undergoing NSM at our single center from January 2015 to December 2020 were retrospectively reviewed.

Results: The nipples were retained in 126 patients (127 breasts), and the areola was retained with nipple excision for five breasts. Frozen section analysis demonstrated a sensitivity of 81.8% and specificity of 95.3%. The NAC recurrence rate was 4.3% over a median follow-up period of 48 (30-105) months. An atypical ductal hyperplasia (ADH) at the margin emerged as an independent factor for NAC recurrence in multivariate Cox regression analysis (hazard ratio, 25.464; 95% confidence interval, 1.841-352.145; p = 0.016). Kaplan-Meier survival analysis revealed no statistically significant reduction in overall survival rates (log-rank test, p = 0.660).

Conclusion: Frozen sections of subareolar tissue are reliable and re-excision may be necessary when ADH is detected at the nipple margin in NSM. The NAC recurrence rate was low, and the outcome was favorable following wide local excision.

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乳头切除术中乳头边缘非典型导管增生的安全性

目的：关于乳头保留乳房切除术（NSM）的禁忌症一直存在争议。本研究旨在评估乳晕下冰冻切片分析的准确性，并确定乳头乳晕复合体（NAC）在NSM术后复发的风险因素：方法：回顾性分析2015年1月至2020年12月在本中心接受NSM手术的原发性浸润性乳腺癌连续病例：结果：126 例患者（127 个乳房）保留了乳头，5 个乳房切除乳头后保留了乳晕。冷冻切片分析显示敏感性为 81.8%，特异性为 95.3%。中位随访期为 48 (30-105) 个月，NAC 复发率为 4.3%。在多变量考克斯回归分析中，边缘处的非典型导管增生（ADH）是导致 NAC 复发的独立因素（危险比为 25.464；95% 置信区间为 1.841-352.145；P = 0.016）。卡普兰-梅耶尔生存分析显示，总生存率在统计学上没有显著下降（对数秩检验，p = 0.660）：结论：乳晕下组织的冷冻切片是可靠的，如果在 NSM 乳头边缘发现 ADH，可能需要再次切除。新乳头状瘤复发率较低，局部广泛切除后疗效良好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Breast Cancer 医学-肿瘤学

CiteScore

3.80

自引率

4.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Breast Cancer (abbreviated as ''J Breast Cancer'') is the official journal of the Korean Breast Cancer Society, which is issued quarterly in the last day of March, June, September, and December each year since 1998. All the contents of the Journal is available online at the official journal website (http://ejbc.kr) under open access policy. The journal aims to provide a forum for the academic communication between medical doctors, basic science researchers, and health care professionals to be interested in breast cancer. To get this aim, we publish original investigations, review articles, brief communications including case reports, editorial opinions on the topics of importance to breast cancer, and welcome new research findings and epidemiological studies, especially when they contain a regional data to grab the international reader''s interest. Although the journal is mainly dealing with the issues of breast cancer, rare cases among benign breast diseases or evidence-based scientifically written articles providing useful information for clinical practice can be published as well.