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A novel nipple–areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients

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Abstract

Background

Nipple-sparing mastectomy (NSM) is increasingly used in breast cancer patients, as it offers better cosmetic outcomes and improves quality of life. Nipple–areola complex (NAC) involvement must be accurately determined to identify which patients may be candidates for NSM. We aimed to identify the predictors of NAC involvement and develop a clinical predictive model to determine the patients for whom NAC preservation may be considered.

Patients and methods

Patients (n = 168) with primary operable breast cancer who underwent subcutaneous mastectomy for breast reconstruction at Saitama Medical Center from July 2013 to December 2017 were selected from the hospital’s surgical database.

Results

The clinicopathological factors of tumor size ≧ 4 cm (p < 0.001), nipple-to-tumor distance (NTD) < 1 cm by mammography (p = 0.002), NTD < 1 cm by magnetic-resonance imaging (MRI) (p < 0.001), nipple contrast findings by MRI (p < 0.001), tumor in central portion (p < 0.001), multicentric/focal lesion (p < 0.001), and clinical node involvement (p = 0.014) were significantly associated with the presence of NAC involvement. Each predictor was scored 0 or 1. A score of 0–3 points was defined as low risk, 4 points as intermediate risk, and 5–7 points as high risk. Using these classification criteria, NAC involvement rate was determined to be 3.5% in low-risk, 68.7% in intermediate-risk, and 90.0% in high-risk specimens. A significant correlation was observed between the risk group and NAC involvement (p < 0.001).

Conclusion

This nipple–areola complex involvement predictive index can be used to determine the appropriate indication for NSM in breast cancer patients who request NAC preservation with more oncological safety.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Surgery, Saitama Medical Center, 4-9-3 Kitaurawa, Urawa-ku, Saitama City, Saitama, 330-0074, Japan

    Hirohito Seki, Takashi Sakurai, Shodai Mizuno, Toshiki Tokuda, Takuji Kaburagi, Minako Seki, Tsuyoshi Karahashi & Kenichiro Nakajima

  2. Division of Pathology, Saitama Medical Center, Saitama, 330-0074, Japan

    Ken Shimizu

  3. Department of Surgery, Teikyo University School of Medicine, Tokyo, 173-8606, Japan

    Hiromitsu Jinno

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  1. Hirohito Seki
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Correspondence to Hirohito Seki.

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This study was approved by the Institutional Review Board of the Saitama Medical Center (IRB no. 18-20).

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Seki, H., Sakurai, T., Mizuno, S. et al. A novel nipple–areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients. Breast Cancer 26, 808–816 (2019). https://doi.org/10.1007/s12282-019-00987-y

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