Positive Nipple Margin After Nipple-Sparing Mastectomy: An Alternative and Oncologically Safe Approach to Preserving the Nipple-Areolar Complex.
Positive Nipple Margin After Nipple-Sparing Mastectomy: An Alternative and Oncologically Safe Approach to Preserving the Nipple-Areolar Complex.
- 2018
BACKGROUND: The aim of this study is to describe a less aggressive approach to management of positive nipple margin following nipple-sparing mastectomy (NSM), allowing for preservation of the nipple-areolar complex (NAC). CONCLUSIONS: Management of positive nipple margin after NSM with subareolar shave biopsy is a safe alternative to preserve the NAC. RESULTS: A total of 819 breasts underwent NSM, yielding a total of 32 breasts (3.9%) with positive nipple margin. Management included 11 (34.4%) subareolar shave biopsies, 15 (46.9%) complete NAC excisions, and 5 (15.6%) with observation alone, plus 1 (3.1%) lost to follow-up. Final pathology after subareolar shave biopsy did not reveal any residual disease, and no patients developed NAC necrosis or required NAC removal. Final pathology after NAC excision revealed 3 of 15 with additional disease (1 invasive ductal carcinoma, 2 DCIS). Of the five patients who had no subsequent intervention, tumor pathology was DCIS in all cases. One patient received adjuvant radiation therapy. Mean time to intervention was 3.7+/-1.9 with mean follow-up of 2.9 years. STUDY DESIGN: A single-institution retrospective chart review was performed for patients undergoing NSM from 1989 to 2017. Positive nipple margin was defined as any residual invasive carcinoma or ductal carcinoma in situ (DCIS) within the additional nipple margin. Management included complete NAC removal, subareolar shave biopsy, or observation alone. Primary outcomes included rates of positive nipple margin and local recurrence.
English
1068-9265
10.1245/s10434-018-6569-4 [doi] 10.1245/s10434-018-6569-4 [pii]
*Breast Neoplasms/su [Surgery]
*Carcinoma, Ductal, Breast/su [Surgery]
*Carcinoma, Intraductal, Noninfiltrating/su [Surgery]
*Mastectomy, Subcutaneous
*Neoplasm, Residual/su [Surgery]
*Nipples/su [Surgery]
Breast Neoplasms/pa [Pathology]
Carcinoma, Ductal, Breast/pa [Pathology]
Carcinoma, Intraductal, Noninfiltrating/pa [Pathology]
Disease Management
Female
Follow-Up Studies
Humans
Margins of Excision
Middle Aged
Neoplasm Invasiveness
Neoplasm, Residual/pa [Pathology]
Nipples/pa [Pathology]
Retrospective Studies
Safety
Treatment Outcome
MedStar Washington Hospital Center
Surgery/General Surgery
Journal Article
BACKGROUND: The aim of this study is to describe a less aggressive approach to management of positive nipple margin following nipple-sparing mastectomy (NSM), allowing for preservation of the nipple-areolar complex (NAC). CONCLUSIONS: Management of positive nipple margin after NSM with subareolar shave biopsy is a safe alternative to preserve the NAC. RESULTS: A total of 819 breasts underwent NSM, yielding a total of 32 breasts (3.9%) with positive nipple margin. Management included 11 (34.4%) subareolar shave biopsies, 15 (46.9%) complete NAC excisions, and 5 (15.6%) with observation alone, plus 1 (3.1%) lost to follow-up. Final pathology after subareolar shave biopsy did not reveal any residual disease, and no patients developed NAC necrosis or required NAC removal. Final pathology after NAC excision revealed 3 of 15 with additional disease (1 invasive ductal carcinoma, 2 DCIS). Of the five patients who had no subsequent intervention, tumor pathology was DCIS in all cases. One patient received adjuvant radiation therapy. Mean time to intervention was 3.7+/-1.9 with mean follow-up of 2.9 years. STUDY DESIGN: A single-institution retrospective chart review was performed for patients undergoing NSM from 1989 to 2017. Positive nipple margin was defined as any residual invasive carcinoma or ductal carcinoma in situ (DCIS) within the additional nipple margin. Management included complete NAC removal, subareolar shave biopsy, or observation alone. Primary outcomes included rates of positive nipple margin and local recurrence.
English
1068-9265
10.1245/s10434-018-6569-4 [doi] 10.1245/s10434-018-6569-4 [pii]
*Breast Neoplasms/su [Surgery]
*Carcinoma, Ductal, Breast/su [Surgery]
*Carcinoma, Intraductal, Noninfiltrating/su [Surgery]
*Mastectomy, Subcutaneous
*Neoplasm, Residual/su [Surgery]
*Nipples/su [Surgery]
Breast Neoplasms/pa [Pathology]
Carcinoma, Ductal, Breast/pa [Pathology]
Carcinoma, Intraductal, Noninfiltrating/pa [Pathology]
Disease Management
Female
Follow-Up Studies
Humans
Margins of Excision
Middle Aged
Neoplasm Invasiveness
Neoplasm, Residual/pa [Pathology]
Nipples/pa [Pathology]
Retrospective Studies
Safety
Treatment Outcome
MedStar Washington Hospital Center
Surgery/General Surgery
Journal Article