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ORIGINAL ARTICLE
Year : 2017  |  Volume : 36  |  Issue : 4  |  Page : 380-388

Prediction of nipple and areola complex invasion in breast cancer patients: clinical and pathological study of surgical specimens


1 Department of General Surgery, Faculty of Medicine, Zagazig, Zagazig University, Egypt
2 Department of Surgical Oncology, Ismailia Teaching Oncology Hospital, Zagazig City, Egypt
3 Department of Surgical Oncology, Faculty of Medicine, Zagazig, Zagazig University, Egypt
4 Department of Pathology, Faculty of Medicine, Zagazig, Zagazig University, Egypt

Correspondence Address:
Wael Elsayed Lotfy Mokhtar
Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_56_17

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Background Nipple–areola sparing (NAS) mastectomy is nowadays considered the most common conservative procedure used for both risk reduction (prophylaxis) and cancer treatment. We regard the oncological safety as a first concern in the management of breast cancer (BC) patients. Aim The aim of this study was to assess the predictive value of clinical and pathological criteria that might affect decision making for NAS mastectomy in BC patients. Patients and methods This study included 60 cases of operable BC that underwent MRM. All specimens were subjected to histopathological examination of the subareolar tissue to prove or disprove malignant infiltration of the nipple–areola complex (NAC), and their data were plotted against the preoperative predictive factors. Results The incidence of occult NAC malignancy was 15%. Predictive factors influencing NAC invasion were tumour–nipple distance less than 4 cm, grade III tumour, lymph node metastasis, lymphovascular invasion, human epidermal growth factor receptor-2 positivity, oestrogen receptor/progesterone receptor negativity, retroareolar/centrally located tumour and multicentric tumours. Conclusion NAS mastectomy for the management of BC would be appropriate in carefully selected patients who have peripherally located tumours, grade I or II, not multicentric or multifocal, with tumour-to-nipple distance greater than 4 cm, and human epidermal growth factor receptor-2 negative with no lymphovascular invasion of the subareolar plexus or axillary lymph nodes metastasis.


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