Tumor-Nipple Distance of ≥ 1 cm Predicts Negative Nipple Pathology After Neoadjuvant Chemotherapy

• Published in: Annals of surgical oncology 2021-10, Vol.28 (11), p.6024-6029
• Main Authors: Moo, Tracy-Ann, Saccarelli, Carolina Rossi, Sutton, Elizabeth J., Sevilimedu, Varadan, Pawloski, Kate R., D’Alfonso, Timothy M., Hughes, Mary C., Gluskin, Jill S., Bitencourt, Almir, Morris, Elizabeth A., Tadros, Audree, Morrow, Monica, Gemignani, Mary L., Sacchini, Virgilio
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Oncology; Chemotherapy; Invasiveness; Magnetic resonance imaging; Mammography; Mastectomy; Medicine; Medicine & Public Health; Oncology; Surgery; Surgical Oncology; Tumors
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-09902-2

Background As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS−) in women undergoing total mastectomy after NAC. Methods Women with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS− was examined and the accuracy of 1 cm TND on imaging for predicting NS− was determined. Results Among 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement ( p