Correlating preoperative clinicopathological factors with skin and/ or nipple–areola complex tumor involvement in postmastectomy specimens

Abstract

Background: Breast cancer is the most commonly diagnosed cancer in women. Breast-conserving surgery is acommon standard for treating many breast cancer patients. However, MRM (Modified radical mastectomy) is still donein ⁓ 30 % of patients undergoing surgeries. Our goal of the study is to identify factors that predict histopathologicalretro-areolar ducts and skin lymphatics tumor involvement, as well as to formulate bases extending the indication of skinsparing, especially nipple–areola complex (NAC) sparing mastectomy.Patients and Methods: The study is an observational analytic study conducted on 145 cases. Inclusion criteria of thestudy are females sex, aged more than 18 years with locoregional breast disease who are candidates for MRM. Exclusioncriteria are cases with grossly involved NAC, inflammatory breast cancer, skin ulceration, and nodules, Paget’s disease ofthe nipple, and candidates for conservative breast surgery.Preoperatively, all patients were subjected to a triple assessment of the breast cancer. Postoperatively, all mastectomyspecimens are sent for the histopathological assessment.Results: By univariate analysis, factors significantly affecting skin and NAC tumor involvement were age, tumor size,multifocality, nodal metastasis, histological grade, localized skin edema (peau d’orange), and lymphovascular invasion.By multivariate analysis, factors significantly increasing skin and NAC tumor involvement were nodal metastasis,localized skin edema, unexposure to neoadjuvant chemotherapy, and HER2 neo positive cases.Conclusion: We can extend indications of SSM (Skin sparing mastectomy) in cases with negative nodal metastasis andabsence of localized skin edema, who were exposed to neoadjuvant chemotherapy and HER2 neo negative cases.