Tumor-nipple Distance Research Articles

Neoadjuvant chemotherapy as an indication to preserve nipple areolar complex in advanced breast cancer.

e12655 Background: Nipple areolar skin sparing mastectomy (NASSM) has similar oncologic and surgical safety compared to skin sparing mastectomy (SSM) and conventional mastectomy. It provides a superior cosmetic outcome, patient satisfaction and quality of life. With the increasing rate of pathological response rate with neoadjuvant chemotherapy (NAT), nipple preservation can be achieved. The aim of our study is to evaluate whether NASSM is an appropriate surgical procedure for patients in whom there is radiological evidence of extension or involvement of nipple areolar complex (NAC) prior to NAT. Methods: Patients with advanced breast cancer received neoadjuvant chemotherapy and NASSM or SSM between June 2006 and December 2021 at Asan Medical Center were retrospectively reviewed. We excluded patients with metastatic breast cancer on presentation, bilateral cancer and inflammatory breast cancer. Kaplan-Meier survival analysis and Cox proportional hazard models were applied to determine clinicopathological and radiological factors to determine NAC preservation. Our primary objective to assess tumor cells persistence in the NAC after radiological complete response or resolution of extension to NAC. Results: Total of 1,105 patients included. 71.7% of patients underwent NASSM and 17.2% SSM as a final operation. 144 patients (13%) had a change in the pre- NAT type of surgery decision. 83(7.5%) patients had nipple involvement on final pathology. Out of 312 patients who underwent SSM, only 76 patients had nipple involvement on final pathology When comparing patients who had nipple involvement to those who didn’t on final pathology, clinical T & N stage, histologic & nuclear grade, breast cancer subtype, presence of multifocality/multicentric disease on MRI pre or post NAT, distance of mass to NAC and mass size pre and post NAT, the presence of non mass extension to NAC post NAT, NAC thickening on any image pre and post NAT and presentation symptoms of nipple retraction and skin changes were statistically significant. A multivariate regression analysis was performed to compare all the above factors and showed that breast cancer subtype, tumor nipple distance on MRI pre NAT, nipple areolar thickening on MRI pre NAT, clinical response and nipple retraction on MMG post NAT were statistically significant and indicators of nipple involvement on final pathology. Only 8 patients developed NAC recurrence in the NASSM group. Conclusions: NASSM is a safe procedure in patients who had tumor extension to NAC prior to NAT and showed improvement post NAT as evident on MRI. Further prospective studies are needed to establish and criteria to preserve NAC in this subgroup of patients.

Factors Associated With Node-Positive Disease in Estrogen Receptor-Positive Breast Cancer Patients

IntroductionLarger tumor size and shorter tumor-to-nipple distance at diagnosis are associated with greater risk of lymph node involvement in breast cancer. However, the relationship between receptor subtype status and lymph node metastasis remains unclear. Our objective was to examine the association between primary tumor size, location, and nodal metastasis across estrogen receptor (ER)+/ progesterone receptor (PR)+/ human epidermal growth factor receptor 2 (HER2)-, ER+/PR-/HER2-, ER+/PR+/HER2+, and ER+/PR-/HER2+ tumors. MethodsA single-institution retrospective chart review was conducted of breast cancer patients diagnosed between 1998 and 2019 who underwent nodal evaluation during primary surgery. Neoadjuvant chemotherapy, pure ductal carcinoma in situ, inflammatory, recurrent, metastatic, bilateral, multicentric, and multifocal disease were excluded. Descriptive statistics (proportions and frequencies for categorical variables and medians [Q1-Q3] for continuous variables) were used to summarize patient characteristics. Kruskal–Wallis test was applied to test the association of outcome variables and continuous variables. Chi-square test or Fisher exact test was applied to test the association of outcome variables and categorical variables. ResultsSix hundred eighteen ER + patients had a median tumor size of 1.7 cm (1.1-2.5 cm). Two hundred ninety six out of 618 (47.9%) were node-positive and 188/618 (30.4%) had axillary dissection. Eighty four point three percent of patients were ER+/PR+/HER2-, 6.31% were ER+/PR-/HER2-, 6.96% were ER+/PR+/HER2+, and 1.13% were ER+/PR-/HER2+. Median tumor size was significantly larger in node-positive cases compared to node-negative cases in ER+/PR+/HER2-, ER+/PR+/HER2+, and ER+/PR-/HER2- subgroups. In ER+/PR+/HER2-patients, median tumor-nipple distance was significantly shorter in node-positive patients compared to node-negative patients. Upper outer quadrant location was significantly associated with nodal positivity in ER+/PR-/HER2- patients. ConclusionsAcross ER + patients, the significance between tumor size, location, and lymph node positivity varied significantly when differentiating by PR and HER2 status.

Factors Predictive of Positive Lymph Nodes for Breast Cancer.

Axillary node status is an important prognostic factor in breast cancer. The primary aim was to evaluate tumor size and other characteristics relative to axillary disease. Single institution retrospective chart review of stage I-III breast cancer patients collected demographic and clinical/pathologic data from 1998-2019. Student's t-test, Chi-squared test (or Fisher exact test if applicable), and logistic regression models were used for testing the association of pN+ to predictive variables. Of 728 patients (mean age 59 yrs) with mean follow up of 50 months, 86% were estrogen receptor +, 10% Her2+, 78% ER+HER2-negative, and 10% triple-negative. In total, 351/728 (48.2%) were pN+ and mean tumor size was larger in pN+ cases compared to pN- cases (mean = 27.7 mm versus 15.5 mm) (p < 0.001). By univariate analysis, pN+ was associated with lymphovascular invasion (LVI), higher grade, Her2, and histology (p < 0.005). Tumor-to-nipple distance was shorter in pN+ compared to pN- (45 mm v. 62 mm; p< 0.001). Age < 60, LVI, recurrence, mastectomy, larger tumor size, and shorter tumor-nipple distance were associated with 3+ positive nodes (p < 0.05). Larger tumor size and shorter tumor-nipple distance were associated with higher lymph node positivity. Age less than 60, LVI, recurrence, mastectomy, larger tumor size, and shorter tumor-nipple distance were all associated with 3+ positive lymph nodes.

Expanded indications for breast-conserving surgery with oncoplastic approaches compared to conventional approaches: a single-center retrospective comparative cohort study.

Oncoplastic breast-conserving surgery (OPBS) is the evolution of conventional breast-conserving surgery (CBCS); however, data from studies comparing patients who received two surgical procedures are limited. A comparison of differences in terms of the patient characteristics, tumor-nipple distance, volume of resected breast tissue, tumor volume and postoperative breast appearance between patients undergoing OPBS and CBCS was carried out in this study, enhancing the evidence base for OPBS by widening indications and improving patient satisfaction. From January 2020 to April 2022, the Breast Center of West China Hospital conducted a retrospective comparative study involving 106 patients. Preoperative characteristics of patients were recorded, and the tumor-nipple distance, the volume of resected breast tissue, tumor volume and patient-reported esthetic outcomes measured by the Harris cosmetic scale were compared between patients who underwent OPBS and CBCS. Each group had a median follow-up time of 2 months, ranging from 1 week to 6 months. The tumor-nipple distance was significantly shorter in patients receiving OPBS than in those receiving CBCS (2.98±1.42 vs. 3.85±1.78 cm, P=0.006). The rate of positive margin evaluated by intraoperative frozen section biopsy was significantly lower in OPBS group than in CBCS group (2/43, 4.65% vs. 11/63, 17.46%; P=0.048). The maximum diameter of resected tissue (7.80±2.29 vs. 6.75±1.87 cm, P=0.011) and volume of resected tissue (74.20±42.77 vs. 45.52±30.99 cm3, P<0.001) were significantly larger with OPBS. The tumor size, tumor volume (either clinically measured by ultrasound or pathologically measured), tumor location, and reoperation rate due to positive margins did not differ significantly between groups. Moreover, insignificant differences existed regarding patient satisfaction between two groups (87.30% vs. 81.40%). The OPBS strategy allowed extensive resections and expanded indications with equivalent cosmetic satisfaction and favorable oncological safety.

Prediction of nipple involvement in breast cancer after neoadjuvant chemotherapy: Should we rely on breast MRI to preserve the nipple?

Indications for nipple sparing mastectomy (NSM) is extending to post-neoadjuvant chemotherapy (NAC) setting. Eligibility for NSM with an optimum tumor-nipple distance (TND) after NAC is unclear. We examined predictive factors for nipple tumor involvement in patients undergoing total mastectomy following NAC. Clinical and pathological data from prospectively collected medical records of women with invasive breast carcinoma, who were undergone NAC and total mastectomy with sentinel lymph node biopsy and/or axillary lymph node dissection were analyzed. PreNAC and postNAC magnetic resonance imaging (MRI)views were examined and a cut-off TND value for predicting the negative nipple tumor status was determined. Among 180 women, the final mastectomy specimen analysis revealed that 12 (7%) had nipple involvement as invasive carcinoma. Patients with nipple involvement had more postNAC multifocal/multicentric tumors (p: 0.03), larger tumors on preNAC and postNAC images (p: 0.002 and p < 0.001), shorter median TNDs on preNAC and postNAC images (7mm-IQR 1.5-14, p: 0.005 and 8.5mm-IQR 3-15.5, p < 0.001, respectively), more nipple retraction on preNAC and postNAC images (p: 0.007 and p: 0.006) and more nipple areola complex skin thickening (> 2mm)on preNAC and postNAC images (p < 0.001 and p: 0.01). The best likelihood ratios (LR) belonged to the postNAC positivity of the <20mm TND, with a + LR of 3.40, and -LR of 0.11 for nipple involvement. PreNAC positivity of the <20mm TND also had a similar -LR of 0.14. A TND-cut-off ≥ 2cm on preNAC and postNAC MRI was shown to be highly predictive of negative nipple tumor involvement.

How to accurately preoperative screen nipple-sparing mastectomy candidate—a nomogram for predicting nipple-areola complex involvement risk in breast cancer patients

BackgroundNipple-sparing mastectomy (NSM) offers superior cosmetic outcomes and has been gaining wide acceptance. It has always been difficult to objectively quantify the risk of nipple-areola complex involvement (NACi). The goal was to develop a prediction model for clinical application.MethodsPatients who had a total mastectomy (TM) between January 2016 and January 2020 at a single institute formed the development cohort (n = 578) and those who had NSM + immediate breast reconstruction (IBR) between January 2020 and January 2021 formed the validation cohort (n = 112). The prediction model was developed using univariate and multivariate logistic regression studies. Based on NACi risk variables identified in the development cohort, a nomogram was created and evaluated in the validation cohort. Meanwhile, stratified analysis was performed based on the model’s risk levels and was combined with intraoperative frozen pathology (IFP) to optimize the model.ResultsTumor central location, clinical tumor size (CTS) > 4.0 cm, tumor-nipple distance (TND) ≤ 1.0 cm, clinical nodal status positive (cN +), and KI-67 ≥ 20% were revealed to be good predictive indicators for NACi. A nomogram based on these major clinicopathologic variables was employed to quantify preoperative NACi risk. The accuracy was verified internally and externally. The diagnostic accuracy of IFP was 92.9%, sensitivity was 64.3%, and specificity was 96.9% in the validation group. Stratified analysis was then performed based on model risk. The diagnostic accuracy rates of IFP and NACiPM in low-risk, intermediate-risk, and high-risk respectively were 96.0%, 93.3%, 83.9%, 61.3%, 66.7%, and 83.3%.ConclusionWe created a visual nomogram to predict NACi risk in breast cancer patients. The NACiPM can be used to distinguish the low, intermediate, and high risk of NAC before surgery. Combined with IFP, we can develop a decision-making system for the implementation of NSM.

A nomogram based on clinical factors for preoperative prediction of nipple involvement in breast cancer

BackgroundAt present, the indication for nipple-sparing mastectomy (NSM) remains inconclusive, and occult nipple involvement (NI) is one of the most important problems when carrying out NSM. Therefore, we aimed to identify the predictive factors of NI, to provide a tool for selecting suitable candidates for NSM.MethodsIn this retrospective study, a total of 250 breast cancer patients who received mastectomy were recruited, and the association between NI and tumor clinicopathologic characteristics was investigated. Nipple signs, tumor size measured by ultrasound (US), and tumor location were developed as a nomogram to predict NI.ResultsAmong the 250 patients, 34 (12.6%) had NI, and 216 (86.4%) did not. In the training group, NI was associated with nipple signs, tumor size, tumor–nipple distance (TND), tumor location, lymph node metastasis, and HER2 overexpression. Both in the training and in the validation groups, NI showed a significant association with nipple signs, tumor size measured by ultrasound, and tumor location. Based on these three clinical factors, the preoperative model nomogram was proved to have high efficiency in predicting NI, possessing a sensitivity of 80.0% and a specificity of 86.7% in the validation group.ConclusionsWe proposed a predictive model nomogram utilizing preoperative tumor characteristics, including nipple signs, tumor size measured by ultrasound, and tumor location. This predictive model could help in the planning of nipple-sparing mastectomy.

Surgical management of nipple areola complex in central breast cancer

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Abstract P3-18-13: A cross-sectional study to investigate association between oncoplastic techniques and patient satisfaction who received breast-conserving surgery

Abstract Background The suture scaffold technique (SST) is one of the oncoplastic techniques used for breast-conserving surgery (BCS), first reported in 2010. There is no report about the cosmetic outcome of SST, so we investigated SST patient satisfaction compared with other techniques. Method We started using the SST in August 2017. The SST requires the construction of scaffolds by using non-absorbable strings in the defect during BCS. The strings are pulled together and tied as close as possible without dimpling the skin from the superior to the inferior direction and medial to the defect's lateral direction. After approval by our institutional ethics committee in September 2020, we started a patient survey using the BREAST-QTM-BCT module (postoperative) version 2.0. We included the patients who received BCS from August 2017 to September 2019, except for cT3, patients who received nipple excision or bilateral breast surgery at our institution. The raw sum scale scores of BREAST-QTM were converted into one score that ranges from 0 (worst) to 100 (best). A score of 4 points is considered to be of minimal importance in breast reconstructive surgery. We utilized a multivariable linear regression model to identify the clinical factors associated with the score. The confounding variables included age, density of the breast, nipple-tumor distance, size of the tumor, location of the tumor, number of lymph nodes dissected, blood loss, and operative duration. Result We identified 437 eligible patients during the study period. Among them, 49 (11.7%) patients received no oncoplastic technique (NOT), 237 (56.8%) patients received mobilization technique of breast tissue (MTB), and 151 (36.2%) patients received SST. SST patients had a higher score than NOT and MTB patients in univariable analysis. In a multivariable model, SST patients had a significantly higher score than NOT (+7.1, 95%CI=0.5-13.0, p=0.03) and an equivalent score to MTB (+1.9, 95%CI=-1.9-5.8, p=0.32) patients. In addition, smaller tumors (+0.13; 95%CI=0.01-0.25) and cases with longer nipple-tumor distance (+1.1; 95%CI=0.24-1.9) showed significantly higher score. Conclusion Among patients who received BCS, the SST patients had higher satisfaction than NOT and equivalent satisfaction to MTB. Additional studies are needed to determine the indications and the limitations of this technique. Table. Multivariate logistic regression analyses for estimating the variables that may affect Rasch score who underwent BCS. Multivariate logistic regression analyses for estimating the variables that may affect Rasch score.Rasch score95% CIp-valueOncoplastic techniqueNOT (49)0 (Reference)BMT (237)5.1-0.7~11.10.08SST (151)7.10.88-13.40.02NTD (cm)1.10.2-1.90.01Size of the tumor (mm)-0.13-0.25~-0.010.02 Citation Format: Reiko Mitsueda, Anri Gen, Yoshitaka Fujiki, Naomi Gondo, Mutsumi Sato, Junko Kawano, Koichi Kuninaka, Shuichi Kanemitsu, Megumi Teraoka, Yoshito Matsuyama, Shinichi Baba, Sugako Nomoto, Robert Sloan, Yoshiaki Rai, Yoshiaki Sagara, Yasuaki Sagara. A cross-sectional study to investigate association between oncoplastic techniques and patient satisfaction who received breast-conserving surgery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-13.

Prediction of nipple-areolar complex involvement by breast cancer: role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

BackgroundSkin-sparing and nipple-sparing mastectomies were considered as alternative techniques for modified radical mastectomy. In patients who are candidates for nipple-sparing mastectomy, preoperative assessment of the nipple-areolar complex (NAC) is essential for adequate surgical planning. Breast MRI is highly sensitive for cancer detection and has an important role in disease staging. The aim of this study was to estimate the role of DCE-MRI in predicting malignant NAC invasion by underlying breast cancer and assess the best predictors on MRI that can suspect malignant NAC invasion.ResultsOut of the 125 patients with breast cancer, 33 patients (26.4%) showed malignant NAC invasion. On basis of multivariate analysis, abnormal nipple enhancement, tumor nipple enhancement, tumor nipple distance ≤ 2 cm, and abnormal and asymmetric nipple morphology were all significant predictors of malignant NAC invasion (P < 0.001) with abnormal unilateral nipple enhancement as the most important independent MRI predictor of malignant NAC invasion (odds ratio = 61.07, 95% CI 12.81–291.22, P < 0.001). When combining more than positive suspicious MRI features, DCE-MRI had 66.6% sensitivity, 76% specificity, 50% PPV, 86.4% NPV, and 73.6% accuracy in prediction of malignant NAC invasion.ConclusionDCE-MRI could predict malignant NAC invasion with abnormal unilateral nipple enhancement as the most important independent MRI predictor.

ASO Author Reflections: Tumor-Nipple Distance of ≥ 1cm on Pre- or Post-Neoadjuvant Chemotherapy Imaging can be used to Determine Eligibility for Nipple-Sparing Mastectomy.

ASO Author Reflections: Tumor-Nipple Distance of ≥ 1cm on Pre- or Post-Neoadjuvant Chemotherapy Imaging can be used to Determine Eligibility for Nipple-Sparing Mastectomy.

Aesthetic utility of addition of nipple-areola recentralization to rotation flap according to nipple tumor distance for patients with lower-outer or upper-inner located breast cancers

We aimed to validate the cosmetic utility of addition of nipple-areola recentralization (NAR) to rotation flap according to nipple tumor distance (NTD) as a volume displacement technique after breast conserving surgery (BCS) for lower-outer and upper-inner breast cancers. Twenty breast cancer patients who had been treated with rotation flap with (Group 1; n = 6) or without (Group 2; n = 14) NAR after BCS for lower-outer or upper-inner located tumors, and those who had undergone BCS without oncoplastic surgical technique for tumors in the same area (Control group; n = 43), were retrospectively investigated. Cosmetic outcome was evaluated using Harvard scale and/or BCCT.core. As a result, the ratio of patients categorized as excellent/good was 83% in Group 1 and 93% in Group 2, respectively, and there was no significant difference between them (P = 0.521). In addition, Group 1 + 2 showed a significantly higher ratio of patients classified as excellent/good than the control group (90% vs. 56%; P = 0.009). After adjustment of clinical background parameters using propensity score matching analysis between Group 1 + 2 and the control group, 12 pairs with similar background factors were matched. Among them, Group 1 + 2 showed a higher ratio of patients categorized as excellent/good than the control group (92% vs. 42%; P = 0.034). In conclusion, addition of NAR to rotation technique according to NTD may enable us to perform a volume displacement after BCS for lower-outer or upper-inner located tumors irrespective of NTD without sacrificing postoperative breast appearance.

Long-Term Oncologic Safety of Nipple-Sparing Mastectomy With Immediate Reconstruction

BackgroundWe assessed the long-term oncologic safety of nipple-sparing mastectomy (NSM) compared to skin-sparing mastectomy (SSM) for primary breast cancer patients with immediate reconstruction. Patients and MethodsData of stage 0-III primary breast cancer patients undergoing NSM (n = 190) or SSM (n = 729) from June 2006 to December 2012 were retrospectively collected. Nipple–tumor distance (NTD) was measured on pretreatment mammography, magnetic resonance imaging, or ultrasonography findings. NSM patients with NTD < 1 cm were excluded. Locoregional recurrence (LRR) rates were compared between groups. Disease-free survival (DFS) and overall survival (OS) according to surgical procedure were assessed. ResultsThe median (range) follow-up period for NSM and SSM was 71 (10-131) months and 79 (9-140) months, respectively. LRR developed in 11 patients with invasive ductal carcinoma (5.8%) for NSM and 44 (42 in patients with invasive ductal carcinoma and 2 in patients with ductal carcinoma-in-situ) (6.0%) for SSM. Hormone receptor and HER2 status were not associated with LRR in either group. DFS and OS rates did not differ between groups (DFS: 89.3% for NSM, 89.3% for SSM, P = .87; OS: 98.4% for NSM, 94.5% for SSM, P = .43). ConclusionNSM with immediate reconstruction was as safe as SSM for primary breast cancer with respect to prognosis and local control, regardless of the presence of invasive carcinoma or breast cancer subtype.

Predictive Factors Among Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in T1-T2 Breast Cancer.

BackgroundThe axillary lymph node status is an important prognostic factor of breast cancer. This study explores the predictive factors for sentinel lymph node (SLN) metastasis among the preoperative clinicopathological features, including impaired glucose tolerance (IGT).MethodsThis study comprised patients diagnosed with breast cancer who underwent surgery at Nagasaki Harbor Medical Center between April 2014 and December 2019. The factors assessed using univariate and multivariate analyses were the clinicopathological data of these cancers, including the patient age, gender, menstrual status, breast or ovarian cancer family history, body mass index, glycosylated hemoglobin, clinical tumor size, nipple-tumor distance (NTD), tumor histology, histological grade, node status, estrogen receptor, progesterone receptor, human epidermal growth factor receptor type 2 status, and Ki67 labeling index.ResultsIn the cohort of 313 cases, the ratio of SLN metastasis was 17.3%. A univariate analysis found that the tumor size, NTD, IGT, and clinical tumor stage were associated with SLN metastasis. In a multivariable analysis, the tumor size, NTD, and IGT were associated with SLN metastasis. The receiver operating characteristic curve showed a sensitivity and specificity of 61.1% and 65.6%, respectively, at a cut-off of 1.7 cm for the tumor size (area under the curve [AUC]: 0.664; 95% confidence interval: 0.592–0.736), and a sensitivity and specificity of 60.4% and 62.9%, respectively, at a cut-off of 2.0 cm for NTD (AUC: 0.651; 95% confidence interval: 0.571–0.731) to predict the risk of SLN metastasis.ConclusionT1 and T2 breast cancer patients with a larger tumor size, tumor located closer to the nipple, and IGT have a higher risk of SLN metastases than others.

MIP image derived from abbreviated breast MRI: potential to reduce unnecessary sub-nipple biopsies during nipple-sparing mastectomy for breast cancer.

To determine the value of a maximum-intensity projection (MIP) image derived from abbreviated breast MRI for excluding occult nipple-areolar complex (NAC) involvement in patients with breast cancer. This prospective study included breast cancer patients with clinically normal NACs between April 2016 and May 2019. Abbreviated breast MRI was performed, and an MIP image was generated for each patient. MIP images were examined for the following features: asymmetric nipple enhancement, tumor-nipple distance (TND), tumor diameter, lesion type, location, and multifocality. Independent predictive MIP features for occult NAC involvement were identified by univariable and multivariable logistic regression analyses. Models based on independent predictive MIP features were developed, and their diagnostic performances were evaluated using ROC analysis. The utility of an MIP image for excluding occult NAC involvement was assessed by considering NPVs across patient subgroups. Eight hundred forty-three patients (67 NAC-positive and 776 NAC-negative) were enrolled. On MIP images, asymmetric nipple enhancement (odds ratio, 6.098; p < 0.001) and TND (odds ratio, 0.564; p = 0.003) were independent predictors of occult NAC involvement. A parallel test model of "asymmetric nipple enhancement or TND ≤ 15 mm" yielded the highest AUC value (0.838) among prediction models. The NPV of MIP images for excluding occult NAC involvement was 99.5%, which was applicable across various patient subgroups. A single MIP image derived from abbreviated breast MRI has utility for excluding occult NAC involvement in breast cancer patients and reducing the number of unnecessary sub-nipple biopsies in nipple-sparing mastectomy. • On MIP images derived from abbreviated breast MRI, asymmetric nipple enhancement and tumor-nipple distance were independent predictors for occult nipple involvement in patients with breast cancer. • Negative findings on MIP image can help select patients at minimal risk of occult nipple involvement, for whom unnecessary intraoperative sub-nipple biopsies in nipple-sparing mastectomy can be omitted.

Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes.

BackgroundSeveral oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio.MethodsAll breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated.ResultsIn total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation.ConclusionsBreast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Distance between tumor and nipple as a prognostic factor in breast cancers: Opposite effects in young and old patients.

The present study aimed to investigate the prognostic implication of distance from tumor to nipple according to clinicopathological factors with known prognostic value.We retrospectively identified 961 patients of invasive breast cancer from January 2000 to April 2016. Clinicopathological information was extracted from hospital database and distance from tumor to nipple was objectively measured during surgeries. Overall survival (OS) and disease-free survival (DFS) were compared among patients with tumor-nipple distance ≤2, 2 to 5, and >5 cm. Subgroup analyses were performed according to age at diagnosis (≤35 vs >35), tumor size, histological features, treatment, axillary nodal metastasis and lymphovascular invasion.A total of 627 cases were included in statistical analysis. There was no difference detected in OS or DFS among patients with different tumor-nipple distance. Better OS was associated with greater tumor-nipple distance in old patients (HR = 0.582, 95%CI: 0.345–0.982, P = 0.042), while the association between OS and tumor-nipple distance was not observed in young patients. DFS was influenced by tumor-nipple distance in both young (HR = 5.321, 95%CI: 1.151–24.595, P = 0.032) and old (HR = 0.593, 95%CI: 0.385–0.913, P = 0.018) patients with opposite effects.Tumor-nipple distance can be adopted as a prognostic factor of breast cancer and it functions oppositely in young and old patients. Multicenter prospective studies with larger sample size are needed to validate the result.

MRI diagnostic features for predicting nipple-areolar-complex involvement in breast cancer

PurposeTo evaluate magnetic resonance imaging (MRI) features including tumor-nipple enhancement for predicting nipple-areolar-complex (NAC) involvement in breast cancer. MethodsA total of 249 breast cancer cases with available preoperative MRI data were studied. On MRI, tumor-nipple enhancement was evaluated 2 min (early) and 6 min (delayed) after contrast injection. Asymmetric nipple enhancement, mass size, tumor-nipple distance, presence of nipple discharge, and enhancement type (mass or non-mass enhancement) were evaluated. ResultsOf the 249 breast cancers, 24 (9.6%) showed NAC involvement. Early tumor-nipple enhancement was found in 37 (14.9%) cancers and delayed tumor-nipple enhancement in 12 (4.8%) cancers. On comparing early and delayed enhancement, 43.2% (16/37) of early tumor-nipple enhancements showed NAC involvement while 25.0% (3/12) of delayed tumor-nipple enhancements showed NAC involvement (P = 0.323). On multivariate analysis, tumor-nipple enhancement (P = 0.004) and tumor-nipple distance with 2 cm cut-off (P = 0.044) were significant. The area under the receiver-operating-characteristic curve (AUC) of early tumor-nipple enhancement was significantly higher (0.787) than that of delayed tumor-nipple enhancement (0.542, P = 0.001). The AUC was the highest when any kind of tumor-nipple enhancement was combined with a tumor-nipple distance of 1 cm (0.878). ConclusionsTumor-nipple enhancement and tumor-nipple distance on MRI could predict NAC involvement in breast cancer. When enhancement was evaluated on both early and delayed phase images with a combined tumor-nipple distance of ≤1 cm, the prediction of NAC involvement showed the best performance.

Use of preoperative mammography, ultrasonography, and MRI to predict nipple areolar complex involvement in breast cancer

To identify the predictive factors of cancer invading into the nipple. Patients with breast cancer undergoing mastectomy between May 2009 and March 2019 were reviewed retrospectively. Of these, those with breast cancer within 2 cm of the nipple areolar complex on ultrasonography were included in this study. Clinicopathological data of the primary tumor and imaging findings from mammography, ultrasonography, and MRI were compared between cases with and without nipple involvement by cancer. In total, 156 of the 821 patients identified were included in the analysis. Of them, 29 had nipple involvement by cancer. Univariate analysis revealed that the following imaging results were significantly associated with nipple involvement: perineural invasion, lymphovascular invasion, lymph node metastasis; relation type between the tumor and the nipple on ultrasonography; periareolar skin thickening on mammography; and short tumor-nipple distance, continuous enhancement between the nipple and tumor, skin enhancement, and nipple enhancement on MRI. However, on multivariate logistic regression analysis, only invasion type of tumor on ultrasonography and nipple enhancement and short tumor-nipple distance on MRI were significantly correlated with nipple involvement by cancer. Imaging findings on preoperative mammography, ultrasonography and MRI are effective predictors for nipple involvement by cancer. Preoperative mammography, ultrasonography, and MRI help predict nipple involvement by breast cancer.

Mammary adenectomy followed by immediate reconstruction for treatment of patients with early-infiltrating breast carcinoma: a cohort study.

Use of mammary adenectomy for breast carcinoma treatment remains controversial. This study aimed to verify the oncological safety of mammary adenectomy and immediate breast reconstruction for treating selected patients with infiltrating breast carcinoma and to evaluate patients' satisfaction with the reconstructed breasts. Cohort study conducted among patients treated at Hospital Sírio-Libanês, São Paulo, Brazil. This study was based on 152 selected patients (161 operated breasts) with infiltrating breast carcinoma who underwent mammary adenectomy and immediate breast reconstruction. In all patients, the diameter of the largest focus of the tumor was less than 3.0 cm, the imaging tumor-nipple distance was greater than 2.0 cm and the pathological assessment showed clear margins. The cumulative incidence of local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method. After at least one year of follow-up, 64 patients were asked about their satisfaction with the reconstructed breast(s). At a mean follow-up time of 43.5 months, seven cases of LR (4.4%), four distant metastases (2.6%) and five deaths (3.3%) were recorded. The five-year actuarial LR-free survival, RFS and OS were 97.6%, 98.3% and 98.3%, respectively. No cases of nipple-areolar complex recurrence were reported. Forty-one patients (64%) indicated a high level of satisfaction with the reconstructed breasts. Mammary adenectomy is a safe and efficacious procedure for selected patients with early-infiltrating breast carcinoma and results in a high rate of patient satisfaction with the reconstructed breasts.