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01-05-2024 | Mastectomy | Breast Oncology

Positive Nipple Margins in Nipple-Sparing Mastectomy: Management of Nipples Containing Cancer or Atypia

Authors: Julia N. Shanno, BS, Abigail E. Daly, BA, Kyle J. Anderman, BS, Heidi S. Santa Cruz, BA, Alexandra J. Webster, BS, Robert M. Pride, MD, Michelle C. Specht, MD, Michele A. Gadd, MD, Tawakalitu O. Oseni, MD, Francys C. Verdial, MD, MPH, Tolga Ozmen, MD, Rebecca Kwait, MD, Amy S. Colwell, MD, Barbara L. Smith, MD, PhD

Published in: Annals of Surgical Oncology

Abstract

Background

Nipple-sparing mastectomy (NSM) is an oncologically safe approach for breast cancer treatment and prevention; however, there are little long-term data to guide management for patients whose nipple margins contain tumor or atypia.

Methods

NSM patients with tumor or atypia in their nipple margin were identified from a prospectively maintained, single-institution database of consecutive NSMs. Patient and tumor characteristics, treatment, recurrence, and survival data were assessed.

Results

A total of 3158 NSMs were performed from June 2007 to August 2019. Nipple margins contained tumor in 117 (3.7%) NSMs and atypia only in 164 (5.2%) NSMs. Among 117 nipple margins that contained tumor, 34 (29%) margins contained invasive cancer, 80 (68%) contained ductal carcinoma in situ only, and 3 (3%) contained lymphatic vessel invasion only. Management included nipple-only excision in 67 (57%) breasts, nipple-areola complex excision in 35 (30%) breasts, and no excision in 15 (13%) breasts. Only 23 (24%) excised nipples contained residual tumor. At 67 months median follow-up, there were 2 (1.8%) recurrences in areolar or peri-areolar skin, both in patients with nipple-only excision. Among 164 nipple margins containing only atypia, 154 (94%) nipples were retained. At 60 months median follow-up, no patient with atypia alone had a nipple or areola recurrence.

Conclusions

Nipple excision is effective management for nipple margins containing tumor. No intervention is required for nipple margins containing only atypia. Our results support broad eligibility for NSM with careful nipple margin assessment.

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Title: Positive Nipple Margins in Nipple-Sparing Mastectomy: Management of Nipples Containing Cancer or Atypia
Authors: Julia N. Shanno, BS
Abigail E. Daly, BA
Kyle J. Anderman, BS
Heidi S. Santa Cruz, BA
Alexandra J. Webster, BS
Robert M. Pride, MD
Michelle C. Specht, MD
Michele A. Gadd, MD
Tawakalitu O. Oseni, MD
Francys C. Verdial, MD, MPH
Tolga Ozmen, MD
Rebecca Kwait, MD
Amy S. Colwell, MD
Barbara L. Smith, MD, PhD
Publication date: 01-05-2024
Publisher: Springer International Publishing
Keyword: Mastectomy
Published in: Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-15362-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Positive Nipple Margins in Nipple-Sparing Mastectomy: Management of Nipples Containing Cancer or Atypia

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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