Histopathological Analysis of Nipple Involvement by Breast Carcinomas in Mastectomy Specimens from a Single Institution
JL Wang, N Iqbal, JM Wang, P Ding, A Chen, P Tai, K Skinner, DG Hicks, P Tang. University of Rochester Medical Center, Rochester, NY; RTI Health Solution, Research Triangle Park, NC
Background: Mastectomy has become less popular among breast cancer patients and surgeons due to effective local control from breast conserving surgery. One of the most important arguments of using mastectomy is to eliminate possible residual tumor involving nipple. Here we analyzed the rates and types of nipple involvement and identified factors that are most strongly associated with disease affecting nipple.
Design: Five hundred thirty-nine mastectomies from the file of the Department of Pathology between 1997 and 2007 were identified. Clinical and pathological factors including patients' age, tumor location, tumor type, uni- or multifocality, tumor size, histological grade, nuclear grade, expression of ER, PR and HER2, margin status, and lymph node status were reviewed and recorded.
Results: Among the 539 breast carcinomas with mastectomies (114 of DCIS, 356 of IDC, 43 of ILC, 22 of IDC with ILC, and 4 of LCIS), 83 (15.4%) cases demonstrated nipple involvement. Nipple involvement was most significantly associated with tumor location (central 33% and 4 quadrants 45% vs 1-3 quadrants 7%-13%; p<0.0001), tumor size (29% in tumors > 5cm vs. 11-15% in tumors < 5cm; p=0.0004), and lymph node status (21% in node positive tumors vs. 11% in node negative tumors; p=0.007). The types of nipple involvement includes DCIS (25 cases), IDC (28 cases), Paget's disease (20 cases), lobular carcinomas (9 cases) and dermal lymphatic invasion (1 case, not included in the calculation). The types of nipple involvement were significantly associated with tumor types (p<0.0001), nuclear grades (p=0.0007), along with tumor location (p<0.0001), tumor size (p<0.0001), and lymph node status (p<0.0001). The nipple involvement and types of involvement were not associated with patients' age, uni-or multifocality, histological grade, status of ER, PR and HER2, and status of margin.
Conclusions: Nipple involvement by breast carcinomas is strongly associated with tumor location, tumor size, and lymph node status. Patients with high risk for nipple involvement should be treated accordingly.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 19, Wednesday Morning