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Pathological Evaluation of Nipple-Sparing Mastectomies with Emphasis on Occult Nipple Involvement: The Weill-Cornell Experience with 325 Cases

Authors

  • Rachel E.K. Eisenberg MD,

    Corresponding author
    1. Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York
    • Address correspondence and reprint requests to: Rachel E. Kaplan Eisenberg, MD, Evelyn H. Lauder Breast and Imaging Center, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, Room 424, New York, NY 10065, USA, or e-mail: rachel.k.eisenberg@gmail.com

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  • Joanna S.Y. Chan MD,

    1. Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York
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  • Alexander J. Swistel MD,

    1. Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York
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  • Syed A. Hoda MD

    1. Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York
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  • Presented in part at the 101st Annual Meeting of the United States and Canadian Academy of Pathology, Vancouver, March 2012.

Abstract

Nipple-sparing mastectomy (NSM) is an increasingly utilized surgical option in managing breast carcinoma; however, data on malignant involvement of a separately submitted nipple margin are scant. Consecutive NSM, including those performed for therapeutic and prophylactic purposes, over a 4-year period (2007–2011), were studied. A separately submitted nipple margin was evaluated by permanent H&E preparations and via frozen section evaluation whenever requested. 325 consecutive NSM specimens, 208 (64%) therapeutic-NSM, and 117 (36%) prophylactic-NSM were studied. All nipples were clinically unremarkable. 86% (179/208) of nipple margins from therapeutic-NSM and 100% (117/117) from prophylactic-NSM showed no histopathologic abnormality. 14% (29/208) of nipple margins from therapeutic-NSM and no nipple margin from prophylactic-NSM showed malignancy. Frozen section evaluation was performed in 188/325 NSM (58%) with a sensitivity of 64% and specificity of 99%. Central tumor location and stage N2/N3 lymph node status were significantly associated with nipple margin positivity (χ2 ≤ 0.05). Subsequent nipple resection was performed in 69% (20/29) of nipple margin-positive cases with residual malignancy found in 40% (8/20, including three cases of invasive carcinoma). In a mean follow-up of 33 months, one invasive carcinoma recurred in the “saved” nipple, 36 months after therapeutic-NSM. 14% (29/208) of nipple margins in therapeutic-NSM and no nipple margin (0/117) in prophylactic-NSM showed malignancy. Central tumor location and N2/N3 stage were significantly associated with nipple margin positivity (χ2 ≤ 0.05).

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