Pathologic Evaluation of Nipple-Areolar Complex Sparing Mastectomy Specimens.
Rhonda Burch-Smith, Gildy Babiera, Regina Fearmonti, Jamie Wagner, Savitri Krishnamurthy. The University of Texas MD Anderson Cancer Center, Houston
Background: Nipple areolar complex (NAC) preservation is an option for patients undergoing skin sparing mastectomy. There are no established guidelines for optimal pathologic evaluation of NAC sparing mastectomy specimens. We report here our approach to the intraoperative and final pathologic evaluation of NAC sparing mastectomy specimens.
Design: NAC sparing mastectomy was performed in patients desiring prophylactic mastectomy and those with stage O, I or II breast cancer, with the index lesion ≥ 2.5cm from NAC. Intraoperative evaluation of the NAC base was performed by frozen sections(FS) of 5 areas: 12 o'clock, 3 o'clock, 6 o'clock, 9 o'clock, and center of the NAC base. The NAC base was also evaluated for the presence of terminal duct lobular units (TDLUs). Perpendicular sections of the same areas, and two representative sections around the NAC base was obtained for final pathologic evaluation to exclude the presence of malignant disease in the areas in close proximity to NAC base.
Results: We studied 44 NAC sparing mastectomy specimens: 27 prophylactic and 17 with breast cancer; 4 invasive ductal carcinoma and 1 invasive lobular carcinoma (mean size-1.4cm), 9 ductal carcinoma in situ(DCIS) (mean size-4.5cm), 1 atypical ductal hyperplasia and 2 atypical lobular hyperplasia (ALH), 2.5cm to 14cm from the nipple. The NAC base showed TDLUs in 41 (93%) specimens. Introperative and final evaluation of the NAC base and the surrounding region was negative for tumor in prophylactic mastectomy specimens and in those with breast cancer was positive for neoplasia in 4/17(24%) : ALH (2) and DCIS (2). While NAC was not preserved in 3, in one patient with DCIS in a lobule, NAC was preserved after focal re-excision of NAC base. Permanent sections of the region around the NAC base was unremarkable in all these patients. After a median follow-up of 18 months, NAC was removed in 2 (1 for ischemia, 1 for malposition) and remained uneventful in 39 (95%) patients.
Conclusions: 1.Intraoperative FS of NAC bae confirms the suitability of the patients for NAC sparing mastectomy. 2.Because of the inability of imaging techniques to detect DCIS without calcations, lobular neoplasia and small foci of invasive cancer, intraoperative sampling of the NAC base alone can rule out involvement of NAC by any type of malignancy.3.The presence of TDLUs in NAC base in 93% of the patients in our study suggests that the oncologic safety of NAC sparing mastectomy can only be determined by long term follow up of the patients.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 30, Tuesday Morning