Avaliação dos fatores preditivos de invasão neoplásica do complexo areolomamilar em pacientes com câncer de mama

Abstract

INTRODUCTION: The choice for having mastectomy with preservation of the nipple-areolar complex (NAC), with better esthetic results, depends on the abscence of neoplastic invasion of the NAC. OBJECTIVE: To identify the predictive factors related to neoplastic NAC invasion. METHODS: We carried out a retrospective, analytical and clinical-pathologic study comprising 48 mastectomy specimens of breast carcinoma from patients treated at Cancer Institute of Paraiba - Napoleao Laureano Foundation (Hospital de Câncer da Paraiba - Fundacao Napoleao Laureano) from April 2007 to January 2008. The mean age was 52.69 ± 10.72. The NAC complex was sectioned separately and perpendicular and parallel cuts were performed from the papilla extending 2 cm deep into the retroareolar tissue (including collecting ducts, lactiferous sinuses and segmental ducts), followed by transverse cuts toward the deep margin. RESULTS: The frequency of NAC involvement by invasive carcinoma was 14.58%. The following characteristics were associated with a higher risk of NAC involvement (p < 0.05): younger patients (mean age 42.3 ± 4.7 years), distance between the tumor and the areola/nipple < 2 cm, size of the areola < 3 cm, histological type (invasive ductal carcinoma associated with comedo type ductal carcinoma in situ), status of axillary lymph nodes (mainly with metastasis in 10 or more lymph nodes), presence of lymphovascular and perineural invasion, and inflammatory infiltrate of intra/peritumoral stroma. Smaller areolas correlated significantly with decreased breast weights (p < 0.0016), which demonstrated that the breast size had a greater impact on NAC involvement in comparison with the tumor diameter. CONCLUSION: The results of this study enabled us to identify factors associated with an increased risk of neoplastic NAC invasion.