背景:保留乳头的乳房切除术(NSM)是乳腺癌治疗和预防的肿瘤学安全方法;然而,对于乳头边缘有肿瘤或异型性的患者,长期的治疗数据很少.
方法:NSM患者乳头边缘有肿瘤或异型,连续NSM的单一机构数据库。患者和肿瘤特征,治疗,复发,和生存数据进行评估。
结果:2007年6月至2019年8月共进行了3158次NSM。117例(3.7%)NSM乳头边缘有肿瘤,仅164例(5.2%)NSM有异型性。在117例乳头边缘中有肿瘤,34(29%)的边缘包含浸润性癌,80(68%)仅包含导管原位癌,3(3%)仅包含淋巴管入侵。管理包括67(57%)乳房的仅乳头切除术,35(30%)乳房的乳头乳晕复合体切除术,15(13%)乳房没有切除。只有23个(24%)切除的乳头含有残留肿瘤。中位随访67个月时,乳晕或乳晕周围皮肤有2例(1.8%)复发,两者都适用于仅乳头切除术的患者。在164个仅包含异型性的乳头边缘中,154(94%)乳头保留。中位随访60个月,单纯异型性患者没有乳头或乳晕复发.
结论:乳头切除术是治疗乳头边缘肿瘤的有效方法。对于仅包含异型性的乳头边缘不需要干预。我们的结果通过仔细的乳头边缘评估支持NSM的广泛资格。
BACKGROUND: Nipple-sparing mastectomy (NSM) is an oncologically safe approach for breast cancer treatment and prevention; however, there are little long-term data to guide management for patients whose nipple margins contain tumor or atypia.
METHODS: NSM patients with tumor or atypia in their nipple margin were identified from a prospectively maintained, single-institution database of consecutive NSMs. Patient and tumor characteristics, treatment, recurrence, and survival data were assessed.
RESULTS: A total of 3158 NSMs were performed from June 2007 to August 2019.
Nipple margins contained tumor in 117 (3.7%) NSMs and atypia only in 164 (5.2%) NSMs. Among 117 nipple margins that contained tumor, 34 (29%) margins contained invasive cancer, 80 (68%) contained ductal carcinoma in situ only, and 3 (3%) contained lymphatic vessel invasion only. Management included
nipple-only excision in 67 (57%) breasts,
nipple-areola complex excision in 35 (30%) breasts, and no excision in 15 (13%) breasts. Only 23 (24%) excised nipples contained residual tumor. At 67 months median follow-up, there were 2 (1.8%) recurrences in areolar or peri-areolar skin, both in patients with nipple-only excision. Among 164
nipple margins containing only atypia, 154 (94%) nipples were retained. At 60 months median follow-up, no patient with atypia alone had a nipple or areola recurrence.
CONCLUSIONS: Nipple excision is effective management for
nipple margins containing tumor. No intervention is required for
nipple margins containing only atypia. Our results support broad eligibility for NSM with careful nipple margin assessment.