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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(11): 1052-1058
DOI: 10.1055/s-0042-1751286
Original Article
Mastology

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

Desfechos oncológicos da mastectomia poupadora do complexo areolo-mamilar em uma população não selecionada avaliada em um único centro
Francisco Pimentel Cavalcante 
1   Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
,
Mirella Macedo Parente Araújo 
2   Grupo de Educação e Estudos Oncológicos, Fortaleza, CE, Brazil
,
Igor Moreira Veras 
3   Centro Regional Integrado de Oncologia, Fortaleza, CE, Brazil
,
Ruffo Freitas-Junior 
4   Department of Obstetrics and Gynecology, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Abstract

Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center.

Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance.

Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively.

Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.

Resumo

Objetivo A mastectomia poupadora do complexo areolo-mamilar (MPM) tem sido tradicionalmente utilizada em casos selecionados com distância tumor-mamilo > 2 cm e biópsia de congelação da base do mamilo negativa. Recomendar MPM em populações não selecionadas continua controverso. Este estudo avaliou os resultados oncológicos de pacientes submetidas à MPM em uma população não selecionada atendida em um único centro.

Métodos Coorte retrospectivo incluindo pacientes não selecionadas com carcinoma invasivo ou carcinoma ductal in situ (CDIS) submetidas à MPM entre 2010 e 2020. Os desfechos incluíram: recorrência locorregional, sobrevida livre de doença (SLD) e sobrevida global (SG), independentemente do tamanho do tumor ou da distância tumor-mamilo.

Resultados Setenta e seis pacientes (média: 46,1 anos de idade) (58 carcinomas invasivos/18 CDIS) foram incluídas. A maioria dos carcinomas invasivos era hormônio-positivo (60%) (superexpressão de HER2: 24%; triplo-negativo: 16%), enquanto 39% dos CDIS eram de alto grau histológico. Os carcinomas invasivos foram T2 em 66% dos casos, com metástases axilares em 38%. As margens cirúrgicas foram todas negativas. Todas as pacientes com carcinoma invasivo receberam tratamento sistêmico e 38% receberam radioterapia. Após um período médio de 34,8 meses, 3 pacientes com carcinoma invasivo (5,1%) e 1 com CDIS (5,5%) apresentaram recidiva local. Durante o acompanhamento, duas pacientes tiveram metástase à distância e vieram a óbito. As taxas de SG e SLD aos 5 anos para carcinoma invasivo foram de 98% e 83%, respectivamente.

Conclusão Em casos não selecionados, os resultados oncológicos de 5 anos após MPM foram considerados aceitáveis e comparáveis a resultados anteriores. Estudos adicionais são necessários.

Keywords

mastectomy - nipple-sparing mastectomy - breast neoplasms - subcutaneous mastectomy - segmental mastectomy

Palavras-chave

mastectomia - mastectomia poupadora do complexo areolo-mamilar - neoplasias mamárias - mastectomia subcutânea - mastectomia segmentar

Contributions

F. P. C. and M. M. P. A. contributed to the conception and design of the study and participated in the acquisition, analysis, and interpretation of the data. All authors contributed to the drafting of the article, revised the manuscript critically for important intellectual content, approved the final version to be published and agree to be accountable for all aspects of the work.




Publication History

Received: 16 February 2022

Accepted: 02 May 2022

Article published online:
29 December 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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