Histological Type Most Commonly Associated with the Invasion of Neoplastic Nipple- Areolar Complex in Patients with Breast Cancer

Abstract

INTRODUCTION: Breast cancer is the most frequent type of cancer among women, registering a relative percentage variation of more than 80% in just over two decades: The standardized mortality rate by age per 100, 000 women, increased from 5. 77 in 1979 to 9. 74 in 2000 (Ministry of Health, 2002). Considering the concept of oncoplastic surgery, mastectomy techniques using periareolar incision and preservation of the nipple-areola complex (NAC) have been carried out, increasing the degree of satisfaction of women affected by breast cancer. MATERIALS AND METHODS: It was studied 48 pieces of mastectomy for female patients, suffering from breast cancer, with a mean age of 52. 69 years ranging between 34 and 75 years who underwent surgery at Cancer Hospital of Paraiba - Napoleon Laureano Foundation. Inclusion criteria were diagnosis of breast cancer, mastectomy as surgical treatment employed, and NAC- free infiltration and other lesions diagnosed by clinical and radiological examination. Exclusion criteria were Paget s disease, status post-neoadjuvant chemotherapy, and macroscopic changes of neoplastic involvement of the NAC. Histological sections of the NAC were made at intervals of 2 mm from the distal portion of the nipple and extending to a depth of 2cm tissue retroareolar. The correlation of histological type with neoplastic involvement of the NAC was performed using multivariate discriminant analysis, where the samples were separated by dimensionless axes in two groups (with and without neoplastic invasion of NAC) and the minimum values ??were estimated for variable histologic type. RESULTS: Among the 48 samples studied, the neoplastic invasion of the NAC was present in 7 cases, with a frequency of 14.58%. Among the 7 patients with neoplastic invasion of the CAM, 6 were found in histologic type infiltrating ductal carcinoma associated with ductal carcinoma in situ (IDC + DCIS) (85. 7%) and 1 case of pure invasive ductal carcinoma (14. 3%). DISCUSSION: The combination of IDC with DCIS appears to be associated with neoplastic involvement of the NAC. The findings of this study corroborate Morimoto et al (1985), who evaluated 141 mastectomy specimens, relating the extension of tumor into the NAC with tumor size, histological type and tumor-nipple distance. They found invasion in 31% (44 cases) and it was observed that this invasion was more frequent when there was extensive intraductal component (82%). CONCLUSION: The association of IDC with DCIS showed a higher possibility of neoplastic involvement of the NAC, which is an important predictor of neoplastic invasion of NAC in patients with breast cancer.