Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer

Julie A Y Billar, Amylou Dueck, Richard J. Gray, Nabil Wasif, Barbara A Pockaj

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Abstract

Background: Proper patient selection is important for nipple-sparing mastectomy, and we aimed to identify preoperative factors predictive of pathologic nipple-areola complex (NAC) involvement to assist with surgical planning. Methods: We retrospectively reviewed a prospectively collected database of patients who underwent mastectomy for DCIS or invasive breast cancer at a single institution. Cases with NAC involvement, NAC(+), were compared with those without NAC involvement, NAC(-). Multivariate logistic regression analysis was performed to determine preoperative factors independently predictive of NAC involvement. Results: A total of 238 standard, 107 skin-sparing, and 47 nipple-sparing mastectomies were performed, and the NAC was pathologically involved in 16% (N = 62). Clinical NAC involvement, as determined by patient symptoms or physical exam, was present in 61% of NAC(?) but only 14% of NAC(-) cases (P<.0001) and carried a 92% negative predictive value (NPV). Preoperative imaging involved the NAC in 38% of NAC(+) but only 4% of NAC(-) cases (P<.0001) and carried an 89% NPV. NAC(+) tumors were larger, with mean size 3.3 cm versus 2.5 cm for NAC(-) tumors (P =.024). The mean tumorto-nipple distance was 2.0 cm for NAC(+) versus 4.7 cm for NAC(-) tumors (P <.0001). On multivariate analysis, independent predictors of NAC involvement were the presence of clinical NAC involvement (odds ratio [OR] 5.11, 95% confidence interval [95% CI] 2.53-10.35) and imaging involvement of the NAC (OR 5.82, 95% CI 2.43-13.94). Conclusions: Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.

Original languageEnglish (US)
Pages (from-to)3123-3128
Number of pages6
JournalAnnals of Surgical Oncology
Volume18
Issue number11
DOIs
StatePublished - Oct 2011

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Nipples
Mastectomy
Breast Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer. / Billar, Julie A Y; Dueck, Amylou; Gray, Richard J.; Wasif, Nabil; Pockaj, Barbara A.

In: Annals of Surgical Oncology, Vol. 18, No. 11, 10.2011, p. 3123-3128.

Research output: Contribution to journalArticle

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title = "Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer",
abstract = "Background: Proper patient selection is important for nipple-sparing mastectomy, and we aimed to identify preoperative factors predictive of pathologic nipple-areola complex (NAC) involvement to assist with surgical planning. Methods: We retrospectively reviewed a prospectively collected database of patients who underwent mastectomy for DCIS or invasive breast cancer at a single institution. Cases with NAC involvement, NAC(+), were compared with those without NAC involvement, NAC(-). Multivariate logistic regression analysis was performed to determine preoperative factors independently predictive of NAC involvement. Results: A total of 238 standard, 107 skin-sparing, and 47 nipple-sparing mastectomies were performed, and the NAC was pathologically involved in 16{\%} (N = 62). Clinical NAC involvement, as determined by patient symptoms or physical exam, was present in 61{\%} of NAC(?) but only 14{\%} of NAC(-) cases (P<.0001) and carried a 92{\%} negative predictive value (NPV). Preoperative imaging involved the NAC in 38{\%} of NAC(+) but only 4{\%} of NAC(-) cases (P<.0001) and carried an 89{\%} NPV. NAC(+) tumors were larger, with mean size 3.3 cm versus 2.5 cm for NAC(-) tumors (P =.024). The mean tumorto-nipple distance was 2.0 cm for NAC(+) versus 4.7 cm for NAC(-) tumors (P <.0001). On multivariate analysis, independent predictors of NAC involvement were the presence of clinical NAC involvement (odds ratio [OR] 5.11, 95{\%} confidence interval [95{\%} CI] 2.53-10.35) and imaging involvement of the NAC (OR 5.82, 95{\%} CI 2.43-13.94). Conclusions: Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.",
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T1 - Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer

AU - Billar, Julie A Y

AU - Dueck, Amylou

AU - Gray, Richard J.

AU - Wasif, Nabil

AU - Pockaj, Barbara A

PY - 2011/10

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N2 - Background: Proper patient selection is important for nipple-sparing mastectomy, and we aimed to identify preoperative factors predictive of pathologic nipple-areola complex (NAC) involvement to assist with surgical planning. Methods: We retrospectively reviewed a prospectively collected database of patients who underwent mastectomy for DCIS or invasive breast cancer at a single institution. Cases with NAC involvement, NAC(+), were compared with those without NAC involvement, NAC(-). Multivariate logistic regression analysis was performed to determine preoperative factors independently predictive of NAC involvement. Results: A total of 238 standard, 107 skin-sparing, and 47 nipple-sparing mastectomies were performed, and the NAC was pathologically involved in 16% (N = 62). Clinical NAC involvement, as determined by patient symptoms or physical exam, was present in 61% of NAC(?) but only 14% of NAC(-) cases (P<.0001) and carried a 92% negative predictive value (NPV). Preoperative imaging involved the NAC in 38% of NAC(+) but only 4% of NAC(-) cases (P<.0001) and carried an 89% NPV. NAC(+) tumors were larger, with mean size 3.3 cm versus 2.5 cm for NAC(-) tumors (P =.024). The mean tumorto-nipple distance was 2.0 cm for NAC(+) versus 4.7 cm for NAC(-) tumors (P <.0001). On multivariate analysis, independent predictors of NAC involvement were the presence of clinical NAC involvement (odds ratio [OR] 5.11, 95% confidence interval [95% CI] 2.53-10.35) and imaging involvement of the NAC (OR 5.82, 95% CI 2.43-13.94). Conclusions: Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.

AB - Background: Proper patient selection is important for nipple-sparing mastectomy, and we aimed to identify preoperative factors predictive of pathologic nipple-areola complex (NAC) involvement to assist with surgical planning. Methods: We retrospectively reviewed a prospectively collected database of patients who underwent mastectomy for DCIS or invasive breast cancer at a single institution. Cases with NAC involvement, NAC(+), were compared with those without NAC involvement, NAC(-). Multivariate logistic regression analysis was performed to determine preoperative factors independently predictive of NAC involvement. Results: A total of 238 standard, 107 skin-sparing, and 47 nipple-sparing mastectomies were performed, and the NAC was pathologically involved in 16% (N = 62). Clinical NAC involvement, as determined by patient symptoms or physical exam, was present in 61% of NAC(?) but only 14% of NAC(-) cases (P<.0001) and carried a 92% negative predictive value (NPV). Preoperative imaging involved the NAC in 38% of NAC(+) but only 4% of NAC(-) cases (P<.0001) and carried an 89% NPV. NAC(+) tumors were larger, with mean size 3.3 cm versus 2.5 cm for NAC(-) tumors (P =.024). The mean tumorto-nipple distance was 2.0 cm for NAC(+) versus 4.7 cm for NAC(-) tumors (P <.0001). On multivariate analysis, independent predictors of NAC involvement were the presence of clinical NAC involvement (odds ratio [OR] 5.11, 95% confidence interval [95% CI] 2.53-10.35) and imaging involvement of the NAC (OR 5.82, 95% CI 2.43-13.94). Conclusions: Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.

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