Nipple-sparing mastectomy for early breast cancer: the importance of intraoperative evaluation of retroareolar margins and intra-nipple duct removal

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Arquivos
art_HEINZEN_Nipplesparing_mastectomy_for_early_breast_cancer_the_importance_2020.PDF (2.35 MB)
Citações na Scopus
3
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
Título da Revista
ISSN da Revista
Título do Volume
Editora
AME PUBL CO
Autores
NIMIR, Cristiane da Costa Bandeira Abrahao
Citação
GLAND SURGERY, v.9, n.3, p.637-646, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Nipple-sparing mastectomy (NSM) is increasingly performed for breast cancer (BC) treatment. To ensure local control with this procedure, it is important to obtain clear surgical margins. Here, we aimed to estimate the confidence in intraoperative evaluation of the retroareolar margin (IERM) and the necessity of removing the intra-nipple ducts. Methods: In this retrospective cohort study, we evaluated 224 BC (infiltrating carcinoma 178, ductal carcinoma in situ 46) patients, who underwent NSM. IERM was determined via cytology and frozen sections. Following gland removal, the intra-nipple ducts were excised and embedded in paraffin for analysis. The retroareolar tissue was also paraffin-embedded and reanalyzed for definitive evaluation of retroareolar margins (DERM). The IERM predictive capacity in relation to DERM and the frequency of intra-nipple duct involvement were estimated. Results: IERM classified the sub-nipple areolar complex area as cancer-free in 219 cases (97.8%). The condition of clear retroareolar margin was confirmed by DERM in 216 cases (98.6%). The IERM accuracy was estimated as 98.6%. Ductal carcinoma in situ was detected in intra-nipple ducts using paraffin sections in 1.8% of the cases, despite dear IERM (4/219). Conclusions: In conclusion, IERM affords high accuracy and its results are suitable to manage the nipple-areolar complex. Nevertheless, some patients may retain residual disease in the intra-nipple ducts; thus, these ducts should ideally be removed during NSM.
Palavras-chave
Breast cancer (BC), nipple-sparing mastectomy (NSM), surgical margins, nipple ducts
URI
https://observatorio.fm.usp.br/handle/OPI/37014
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - LIM/02
Artigos e Materiais de Revistas Científicas - LIM/14
Artigos e Materiais de Revistas Científicas - ODS/03