J Breast Cancer.  2024 Aug;27(4):260-269. 10.4048/jbc.2024.0077.

Safety of Atypical Ductal Hyperplasia at the Nipple Margin in Nipple-Sparing Mastectomy

• Zhu M
• Mao J
• Fang J
• Chen D

• KMID: 2559305
• DOI: http://doi.org/10.4048/jbc.2024.0077

Abstract

Purpose
Controversies persist regarding contraindications for nipple-sparing mastectomy (NSM). This study aimed to assess the accuracy of subareolar frozen section analysis and identify risk factors for nipple-areola complex (NAC) recurrence post NSM.
Methods
Consecutive cases of primary invasive breast cancer undergoing NSM at our single center from January 2015 to December 2020 were retrospectively reviewed.
Results
The nipples were retained in 126 patients (127 breasts), and the areola was retained with nipple excision for five breasts. Frozen section analysis demonstrated a sensitivity of 81.8% and specificity of 95.3%. The NAC recurrence rate was 4.3% over a median follow-up period of 48 (30–105) months. An atypical ductal hyperplasia (ADH) at the margin emerged as an independent factor for NAC recurrence in multivariate Cox regression analysis (hazard ratio, 25.464; 95% confidence interval, 1.841–352.145; p = 0.016). Kaplan-Meier survival analysis revealed no statistically significant reduction in overall survival rates (log-rank test, p = 0.660).
Conclusion
Frozen sections of subareolar tissue are reliable and re-excision may be necessary when ADH is detected at the nipple margin in NSM. The NAC recurrence rate was low, and the outcome was favorable following wide local excision.

Keyword

Breast Neoplasms; Mastectomy; Plastic Surgery Procedures; Recurrence