Prediction of Nipple and Areola Complex Invasion in Breast Cancer Patients. Clinical and Pathological Study of Surgical Specimens

Breast conservation surgery (BCS) and nipple-areola-sparing (NAS) mastectomy have been recognized as two milestones in this period. This study included 60 Egyptian female patients with breast cancer, all of them were subjected to modified radical mastectomy operation. Methods: This study included female patients > 18 years old who have breast cancer with healthy looking non invaded skin of nipple and areola and excluded patients < 18 years old, patients unfit for surger, patients previously subjected to chemo or radiotherapy for breast cancer. We peformed clinical examination of 60 patients with breast cancer. We studied the relevant factors that affect NAC invasion such as patient’s age, menstrual state, family history, tumor size, tumor location (central vs peripheral), tumor to nipple distance, lymphovascular invasion of NAC, lymph node metastasis, histological tumor type, tumor stage, multifocal/multicentric tumors and (ER, PR, HER2) status. Result: In our study, we have shown that NAC invasion is strongly associated with: 1) Nipple retraction as a patient’s complaint; 2) Tumor site; 3) Tumor-nipple-distance ≤ 4 cm; 4) Multifocal/multicentric tumor; 5) Tumor grade (grade III tumors); 6) Positive lymph node invasion; 7) ER and PR receptors negativity; 8) HER2 positivity. This helps in preoperative planning for selecting patients for NAS mastectomy. Conclusion: The ideal patients for NAS mastectomy are with these criteria: 1) Clinically normal nipple areola complex; 2) Distance from the tumor to the nipple is >4 cm; 3) No multifocal/multicentric tumor; 4) Absence of lymph node invasion; 5) Tumor grade (grade I, II); 6) Peripheral not central tumor; 7) No sub-areolar lymphovascular invasion (LVI); 8) ER receptor positive; 9) PR receptor positive; 10) HER2 negative.