Intraoperative Evaluation of the Nipple Margin in the Decision Making for Nipple Sparing Mastectomies
Andrea L Barbieri, Veerle Bossuyt. Yale-New Haven Hospital, New Haven, CT
Background: Nipple-sparing mastectomies (NSMs) are increasingly performed for the surgical treatment of invasive and in situ breast cancer. Evaluation of the nipple margin by frozen section is used to decide at the time of surgery whether or not to preserve the nipple. We examined the effectiveness of this approach.
Design: We studied a consecutive series of NSMs at our institution (6-2010 to 5-2011). Discrepancies between frozen section and final permanent diagnoses were recorded. We retrospectively reviewed both frozen section and permanent slides of all cases.
Results: Sixty five nipple-sparing mastectomies were sent to Pathology in one year, Fifty five (85%) with seperate designated "nipple-core" margins. Of these 55 nipple margins, 41 (75%) were sent for intraoperative evaluation.
|Number of Cases||Frozen Section Diagnosis||Permanent Diagnosis||Nipple Preserved?|
|31||Benign breast tissue||Confirmed||Y (Yes)|
|1||Minimal epithelial proliferation with atypia||Discrepant, Benign breast tissue||Y|
|1||Extensive involvement by invasive lobular carcinoma||Confirmed||N (No)|
|1||Papillary lesion, no evidence of carcinoma||Confirmed||Y|
|1||Focal intraductal proliferation suspicious for atypia||Discrepant, Benign breast tissue||N|
|1||IDP with intraductal hyperplasia||Confirmed||Y|
|1||Cannot rule-out low grade DIN||Confirmed||Y|