Histopathological Analysis of Nipple Areola Complex Involvement by Breast Carcinoma in 787 Consecutive Therapeutic Mastectomy Specimens from a Single Institution.
Jianli Wang, Xiuli Xiao, Jainmin Wang, Huijiao Chen, Laurie Baxter, Kristin Skinner, David Hicks, Ping Tang. Univeristy of Rochester Medical Center, NY; RTI Health Solution, Research Triangle Park, NC
Background: Breast conserving therapy (BCT) has become the standard of care for majority of the breast cancer patients. However, mastectomy is often required when patients are not candidates for BCT or not wish to undergo BCT. One of the arguments for mastectomy is that it can eliminate possible occult disease involving nipple areola complex (NAC).
Design: Here we analyzed the rates and types of NAC involvement and factors associated with it in 787 consecutive therapeutic mastectomies in our institution between 1997 and 2009. Clinical and pathological factors including patients' age, tumor location, tumor type, tumor 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 787 breast carcinomas with mastectomies (488 for IDC, 197 for DCIS, 63 for ILC, 22 for IDC plus ILC, 13 LCIS and 4 for phyllodes tumor), 82 (10.42%) cases demonstrated NAC involvement, which included DCIS (17 cases), IDC (15 cases), Paget's disease (26 cases), LCIS (11 cases), ILC (3 cases), intraductal papilloma (3 cases), dermal lymphatic invasion (4 case), and other lesions (3 cases). All 6 clinically diagnosed cases were Paget's, and 21 grossly diagnosed cases were 12 Paget's disease, 5 IDC, 2 LCIS, 1 DCIS, and 1 LVI. NAC involvement was most significantly associated with tumors involving all 4 quadrants (p<0.0001), tumors greater than 5cm (p=0. 0012 and p=0.0061 for invasive and in situ carcinoma), and tumors with high histologic grade (p=0.0315) and HER2 over-expression (p=0.0403). The NAC involvement was not associated with the age of patients, tumor type, tumor multifocality, nuclear grade, status of surgical margin, status of lymph node, and ER and PR expression.
Conclusions: In conclusion, only 8.5% and 25.6% of nipple lesions can be identified clinically and grossly, respectively; NAC involvement is strongly associated with tumors present in all 4 quadrants, large tumor size, high histologic grade, and HER2 over-expression. Appropriate surgical procedure should be used based on each patient's relative risk for NAC involvement.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 31, Tuesday Morning