Nipple margin assessment at the time of nipple-sparing mastectomy

Article Figures & Tables

Table 1

Patient and tumour characteristics

Characteristic	Patients with cancer n = 242	Patients undergoing CPM n = 69	Patients undergoing BPM n = 26
Age, yr, mean	52	51.4	49.7
Female, n	242	69	26
Size of lesion on imaging, mm,^* mean	21.6	7.54	0
Tumour histology
DCIS, n	41	5	1
Size of DCIS, mm, mean (range)	21.7 (0–85)	4.3 (1–9)	1
Invasive cancer, n	201	1	—
Size of invasive cancer, mm, mean (range)	16.9 (0–57)	1	—
T stage, n
Tis	41	5	1
T1	106	—	—
T2	44	—	—
T3	3	—	—
T4	—	—	—
Nottingham grade, n
I	42	5	1
II	84	—	—
III	68	—	—
Axillary procedure, n
SLNB	185	3	—
ALND	22	—	—
None	35	66	26
Nodal status, n
Node positive	57/207	—	—
Node negative	150/207	3/3	—
Lymphovascular invasion, n
Yes	52/242	1/6	—
No	108/242	—	1/1
Invasive tumour subtype, n
HR+/HER2−	63/201	2/6	—
HR+/HER2+	10/201	1/6	—
HR−/HER2−	13/201	1/6	—
HR−/HER2+	9/201	—	—
Median follow-up, mo	33.7	44.1	—
Neoadjuvant therapy, n
Yes	31	—	—
No	211	69	26
Adjuvant therapy, n
Chemotherapy	68	—	—
Radiation therapy	70	—	—
Endocrine therapy	137	—	—

ALND = axillary lymph node dissection; BPM = bilateral prophylactic mastectomy; CPM = contralateral prophylactic mastectomy; DCIS = ductal carcinoma in situ; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; SD = standard deviation; SLNB = sentinel lymph node biopsy.
↵* Largest size modality of imaging was used among ultrasonography, magnetic resonance imaging and mammogram.

Table 2

Nipple margin assessment outcomes among patients with cancer or undergoing CPM and BPM who underwent nipple sparing mastectomy

Outcome	Patients with cancer n = 242	Patients undergoing CPM n = 69	Patients undergoing BPM n = 26	p value
Nipple margin assessment performed	222/242	57/69	17/26	< 0.001
Positive margin	10/222	—	—	0.18
Surgery based on nipple margin result	7/10	—	—	—

BPM = bilateral prophylactic mastectomy; CPM = contralateral prophylactic mastectomy.

Table 3

Tumour characteristics of patients with a positive nipple margin (n = 10)

Patient	Tumour histology	Tumour size on imaging, cm	Tumour size on pathology, cm	Clinical distance to nipple, cm	Radiological distance to nipple, cm	NAT or upfront surgery	Incision for NSM	Management of positive nipple biopsy	Adjuvant therapy
1	DCIS	1.5	3.2	Not palpable	3	Surgery	Inframammary fold	NAC excision	None
2	DCIS	3.8	0^*	Unknown	0.8	Surgery	Inframammary fold	Observation	None
3	Invasive cancer	4.0	3.5	Not palpable	5.5	Surgery	Radial	NAC excision	Endocrine
4	Invasive cancer	0.1	1.7	NA^†	NA^†	Surgery	Inframammary fold	NAC excision	Chemotherapy, RT and endocrine
5	Invasive cancer	1.5	2.2	5	4	Surgery	Inframammary fold	NAC excision	Chemotherapy, RT and endocrine
6	Invasive cancer	7	4.0	5	5	NAT	Inframammary fold	NAC excision	RT and endocrine
7	Invasive cancer	3	1.2	Unknown	6	NAT	Inframammary fold	NAC excision	RT and endocrine
8	Invasive cancer	0.9	1.6	7	7	Surgery	Radial	NAC excision	Endocrine
9	DCIS	9	8.0	2	5	Surgery	Circumareolar with lateral extension	Observation	None
10	DCIS	4.1	4.0	0.5	2	Surgery	Inframammary fold	Observation	Chemotherapy, RT and endocrine

DCIS = ductal carcinoma in situ; NA = not applicable; NAC = nipple-areolar complex; NAT = neoadjuvant therapy; NSM = nipple sparing mastectomy; RT = radiation therapy.
↵* Multifocal DCIS.
↵† Patient had a normal mammogram and ultrasonography performed, but had a palpable mass in the axillary tail of left breast, that was excised and revealed invasive lobular cancer with positive margins. The patient had bilateral magnetic resonance imaging (normal), but elected to proceed with NSM.