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01-06-2015 | Review

Predictive factors of nipple involvement in breast cancer: a systematic review and meta-analysis

Authors: Hanwen Zhang, Yaming Li, Meena S. Moran, Bruce G. Haffty, Qifeng Yang

Published in: Breast Cancer Research and Treatment | Issue 2/2015

Abstract

Nipple-sparing mastectomy (NSM) provides a cosmetic and psychological benefit for patients, but concerns on nipple involvement (NI) of tumor continue to persist. Several studies have reported factors for predicting NI, but the results were inconsistent and uncomprehensive, making patient selection difficult. The aim of the systematic review was to pool the published data to further discern factors associated with NI. A literature review was conducted of PubMed database, following the PRISMA guidelines. Relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using random-effect or fix-effect model. Publication bias and Chi-square test were also calculated. From 1978 to 2014, 27 clinical studies with 7971 patients met the inclusion criteria. Predictive factors suggest higher rates of NI including the following: tumor-to-nipple distance (TND) ≤ 2.5 cm (3.65, 1.42–9.33); positive lymph node status (2.09, 1.71–2.57); stage III or IV disease (2.41, 1.93–3.00); tumor size > 5 cm (2.42, 1.95–3.02); estrogen receptor (ER)-negative status (1.19, 1.01–1.40); progesterone receptor (PR)-negative status (1.52, 1.25–1.84); HER-positive status (1.76, 1.46–2.12); patients with ductal carcinoma in situ (DCIS) compared with invasive ductal carcinoma (1.55, 1.16–2.08). Due to the statistical heterogeneity detected with certain parameters, further investigations to confirm their association with NI will be needed. Patients with one or more risk factors such as centrally located tumors; higher tumor stage; large tumors; ER-negative/PR-negative/HER-positive status and associated DCIS have higher risk of NI. Taking these factors into consideration comprehensively may help with decision-making process for NSM.

Murthy V, Chamberlain RS (2013) Nipple-sparing mastectomy in modern breast practice. Clin Anat 26(1):56–65CrossRefPubMed

Long L (2013) The use of nipple-sparing mastectomy in patients with breast cancer. Clin J Oncol Nurs 17(1):68–72CrossRefPubMed

Weidong L et al (2011) Nipple involvement in breast cancer: retrospective analysis of 2323 consecutive mastectomy specimens. Int J Surg Pathol 19(3):328–334CrossRef

Alperovich M et al (2013) Nipple-sparing mastectomy in patients with a history of reduction mammaplasty or mastopexy: how safe is it? Plast Reconstr Surg 131(5):962–967CrossRefPubMed

Nahabedian MY, Tsangaris TN (2006) Breast reconstruction following subcutaneous mastectomy for cancer: a critical appraisal of the nipple-areola complex. Plast Reconstr Surg 117(4):1083–1090CrossRefPubMed

Bassiouny M et al (2005) Quadrantectomy and nipple saving mastectomy in treatment of early breast cancer: feasibility and aesthetic results of adjunctive latissmus dorsi breast reconstruction. J Egypt Natl Canc Inst 17(3):149–157PubMed

Cense HA et al (2001) Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol 27(6):521–526CrossRefPubMed

Tokin C et al (2012) Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol 2012:921821PubMedCentralPubMed

Wang J et al (2012) Predictors of nipple–areolar complex involvement by breast carcinoma: Histopathologic analysis of 787 consecutive therapeutic mastectomy specimens. Ann Surg Oncol 19(4):1174–1180CrossRefPubMedCentralPubMed

10.

Brachtel EF et al (2009) Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens. J Clin Oncol 27(30):4948–4954CrossRefPubMed

11.

Mallon P et al (2013) The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg 131(5):969–984CrossRefPubMed

12.

Maxwell GP et al (2011) Advances in nipple-sparing mastectomy: oncological safety and incision selection. Aesthet Surg J 31(3):310–319CrossRefPubMed

13.

Mladenov M, Chervenyakov P, Daskalova I (2010) Nipple-sparing mastectomy (subcutaneal mastectomy with preserving of the areolomammilar complex) like alternative of the modify radical mastectomy in selected cases. Khirurgiia (Sofiia) 6:23–27

14.

Algaithy ZK et al (2012) Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol 38(2):125–129CrossRefPubMed

15.

Psaila A et al (2006) Nipple sparing mastectomy with immediate breast reconstruction: a short term analysis of our experience. J Exp Clin Cancer Res 25(3):309–312PubMed

16.

Rivolin A et al (2012) Nipple-areola complex sparing mastectomy with periareolar pexy for breast cancer patients with moderately ptotic breasts. J Plast Reconstr Aesthet Surg 65(3):296–303CrossRefPubMed

17.

Munhoz AM et al (2013) Clinical outcomes following nipple-areola-sparing mastectomy with immediate implant-based breast reconstruction: a 12 year experience with an analysis of patient and breast-related factors for complications. Breast Cancer Res Treat 140(3):545–555CrossRefPubMed

18.

Voltura AM et al (2008) Nipple-sparing mastectomy: critical assessment of 51 procedures and implications for selection criteria. Ann Surg Oncol 15(12):3396–3401CrossRefPubMed

19.

Garcia-Etienne CA et al (2009) Nipple-sparing mastectomy: initial experience at the Memorial Sloan-Kettering Cancer Center and a comprehensive review of literature. Breast J 15(4):440–449CrossRefPubMed

20.

Chung AP, Sacchini V (2008) Nipple-sparing mastectomy: where are we now? Surg Oncol 17(4):261–266CrossRefPubMed

21.

Burdge EC et al (2013) Nipple skin-sparing mastectomy is feasible for advanced disease. Ann Surg Oncol 20(10):3294–3302CrossRefPubMed

22.

Bistoni G et al (2006) Nipple-sparing mastectomy. Preliminary results. J Exp Clin Cancer Res 25(4):495–497PubMed

23.

Caruso F et al (2006) Nipple sparing subcutaneous mastectomy: 66 months follow-up. Eur J Surg Oncol 32(9):937–940CrossRefPubMed

24.

Wellisch DK et al (1987) The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg 80(5):699–704CrossRefPubMed

25.

Rulli A et al (2013) Oncologic reliability of nipple-sparing mastectomy for selected patients with breast cancer. Vivo 27(3):387–394

26.

Stanec Z et al (2013) Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15 year experience. Ann Plast Surg 26(1):56–65

27.

Sakurai T et al (2013) Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol 30(1):1–7CrossRef

28.

Shi A et al (2012) Subcutaneous nipple-sparing mastectomy and immediate breast reconstruction. Breast Care (Basel) 7(2):131–136CrossRef

29.

Eisenberg RE et al (2014) Pathological evaluation of nipple-sparing mastectomies with emphasis on occult nipple involvement: the Weill-Cornell experience with 325 cases. Breast J 20(1):15–21CrossRefPubMed

30.

Sakurai T et al (2013) Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol 30(1):481CrossRefPubMed

31.

Menon RS, van Geel AN (1989) Cancer of the breast with nipple involvement. Br J Cancer 59(1):81–84CrossRefPubMedCentralPubMed

32.

Ananthakrishnan P, Feldman S (2012) Nipple-sparing mastectomy: indications, oncologic safety. Minerva Chir 67(3):257–270PubMed

33.

Garcia-Etienne CA, Borgen PI (2006) Update on the indications for nipple-sparing mastectomy. J Support Oncol 4(5):225–230PubMed

34.

Matrai Z et al (2011) Role of nipple sparing mastectomy in modern breast surgery. Orv Hetil 152(31):1233–1249CrossRefPubMed

35.

Kryvenko ON et al (2013) Prevalence of terminal duct lobular units and frequency of neoplastic involvement of the nipple in mastectomy. Arch Pathol Lab Med 137(7):955–960CrossRefPubMed

36.

Rosen PP, Tench W (1985) Lobules in the nipple. Frequency and significance for breast cancer treatment. Pathol Annu 20(Pt 2):317–322PubMed

37.

Stolier AJ, Wang J (2008) Terminal duct lobular units are scarce in the nipple: implications for prophylactic nipple-sparing mastectomy: terminal duct lobular units in the nipple. Ann Surg Oncol 15(2):438–442CrossRefPubMed

38.

Reynolds C et al (2011) Prophylactic and therapeutic mastectomy in BRCA mutation carriers: can the nipple be preserved? Ann Surg Oncol 18(11):3102–3109CrossRefPubMed

39.

Gulben K, Yildirim E, Berberoglu U (2009) Prediction of occult nipple-areola complex involvement in breast cancer patients. Neoplasma 56(1):72–75CrossRefPubMed

40.

Pirozzi PR et al (2010) Clinical and morphological factors predictive of occult involvement of the nipple-areola complex in mastectomy specimens. Eur J Obstet Gynecol Reprod Biol 148(2):177–181CrossRefPubMed

41.

Luttges J, Kalbfleisch H, Prinz P (1987) Nipple involvement and multicentricity in breast cancer. A study on whole organ sections. J Cancer Res Clin Oncol 113(5):481–487CrossRefPubMed

42.

Billar JA et al (2011) Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer. Ann Surg Oncol 18(11):3123–3128CrossRefPubMed

43.

D’Alonzo M et al (2012) Clinical and radiological predictors of nipple-areola complex involvement in breast cancer patients. Eur J Cancer 48(15):2311–2318CrossRefPubMed

44.

Schecter AK et al. (2006) Applicability of the nipple-areola complex-sparing mastectomy: a prediction model using mammography to estimate risk of nipple-areola complex involvement in breast cancer patients. Ann Plast Surg 56(5): 498–504, discussion 504

45.

Quinn RH, Barlow JF (1981) Involvement of the nipple and areola by carcinoma of the breast. Arch Surg 116(9):1139–1140CrossRefPubMed

46.

Banerjee A, Gupta S, Bhattacharya N (2008) Preservation of nipple-areola complex in breast cancer–a clinicopathological assessment. J Plast Reconstr Aesthet Surg 61(10):1195–1198CrossRefPubMed

47.

Kissin MW, Kark AE (1987) Nipple preservation during mastectomy. Br J Surg 74(1):58–61CrossRefPubMed

48.

Gomez C et al (2014) The role of radiation therapy after nipple-sparing mastectomy. Ann Surg Oncol 21(7):2237–2244CrossRefPubMed

49.

Bistoni G et al (2006) Nipple-sparing mastectomy. Prelim Results 25:495–497

50.

Crowe JP Jr et al (2004) Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg 139(2):148–150CrossRefPubMed

51.

Morimoto T et al (1985) Involvement of nipple and areola in early breast cancer. Cancer 55(10):2459–2463CrossRefPubMed

52.

Vyas JJ, Chinoy RF, Vaidya JS (1998) Prediction of nipple and areola involvement in breast cancer. Eur J Surg Oncol 24(1):15–16CrossRefPubMed

53.

Stolier A et al (2013) A comparison of clinical and pathologic assessments for the prediction of occult nipple involvement in nipple-sparing mastectomies. Ann Surg Oncol 20(1):128–132CrossRefPubMed

54.

Crowe JP et al. (2008) Nipple-sparing mastectomy update: one hundred forty-nine procedures and clinical outcomes. Arch Surg 143(11): 1106–10m, discussion 1110

55.

Wertheim U, Ozzello L (1980) Neoplastic involvement of nipple and skin flap in carcinoma of the breast. Am J Surg Pathol 4(6):543–549CrossRefPubMed

56.

Simmons RM et al (2002) Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol 9(2):165–168CrossRefPubMed

57.

Byon W et al (2014) Magnetic resonance imaging and clinicopathological factors for the detection of occult nipple involvement in breast cancer patients. J Breast Cancer 17(4):386–392CrossRefPubMedCentralPubMed

58.

Steen ST et al (2013) Predicting nipple-areolar involvement using preoperative breast MRI and primary tumor characteristics. Ann Surg Oncol 20(2):633–639CrossRefPubMed

59.

Santini D et al (1989) Neoplastic involvement of nipple-areolar complex in invasive breast cancer. Am J Surg 158(5):399–403CrossRefPubMed

60.

Moran MS, Schnitt S, Giuliano AE, Harris JR, Khan SA, Horton J et al (2014) Society of surgical oncology-american society for radiation oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages i and ii invasive breast cancer. J Clin Oncol 88(3):553–564

61.

Lagios MD et al (1979) A guide to the frequency of nipple involvement in breast cancer. A study of 149 consecutive mastectomies using a serial subgross and correlated radiographic technique. Am J Surg 138(1):135–142CrossRefPubMed

62.

Vlajcic Z et al (2005) Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg 55(3):240–244CrossRefPubMed

63.

Laronga C et al (1999) The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 6(6):609–613CrossRefPubMed

64.

Lambert PA, Kolm P, Perry RR (2000) Parameters that predict nipple involvement in breast cancer. J Am Coll Surg 191(4):354–359CrossRefPubMed

Title: Predictive factors of nipple involvement in breast cancer: a systematic review and meta-analysis
Authors: Hanwen Zhang
Yaming Li
Meena S. Moran
Bruce G. Haffty
Qifeng Yang
Publication date: 01-06-2015
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2015
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-015-3385-4

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