Surgical management of nipple areola complex in central breast cancer / 中华肿瘤杂志

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Central Lumpectomy with Resection of the Nipple-areolar Complex for Retroareolar or Central Breast Cancers

PURPOSE: This study was conducted to evaluate the outcome of central lumpectomy for breast conservation including nipple-areolar resection and postoperative radiation therapy in patients with central breast cancers. METHODS: 19 patients with central breast cancers, aged 39 to 72 years, operated on from May 2004 to March 2010 were identified. Recurrence, survival, and cosmesis were analyzed. Treatment was undertaken as complete excision of the nipple-areolar complex (NAC), followed by external radiation to the whole breast and tumor bed. The mean follow-up period was 37.9 (1 to 71) months. RESULTS: At pathology, 13 had invasive ductal carcinoma; 5 had ductal carcinoma in situ. 1 had neuroendocrine cancer. Only 1 had atypical ductal hyperplasia at resection margin; the remaining 18 were free margins. The mean tumor size was 1.6 cm (range, 0.8~4 cm) and the distance from the nipple was 0~1 cm. 37.5% had positive axillary nodes. Adjuvant chemotherapy was given for 12 patients, followed by radiation therapy. All 15 patients, who were hormone receptor positive, were given tamoxifen or aromatase inhibitors. With a mean follow up of 37.9 months, all 19 patients are alive and free of disease. Cosmetic results ranged from good to excellent in 18 (94.7%) patients, as judged by both the patients and the surgeons. CONCLUSION: Although this study needs further evaluation and long-term follow up, subareolar or central breast cancers can be successfully treated with breast conserving therapy using nipple-areolar resection and postoperative radiation therapy, along with acceptable cosmesis.