Keywords:
Breast, Oncology, MR, Mammography, Efficacy studies, Safety, Surgery, Neoplasia, Multidisciplinary cancer care, Psycho-oncology
Authors:
R. CAPOCCI1, V. Tacher2, R. Bosc1, J.-L. Totobenazara1, H. Kobeiter1, A. Luciani1, E. MEYBLUM2, T. H. Dao1; 1Créteil/FR, 2PARIS/FR
DOI:
10.26044/ecr2019/C-2627
Aims and objectives
Extended (> 3 cm in diameter) or multifocal ductal carcinoma in-Situ (DCIS) have an indication for mastectomy.
During the past 30 years,
surgical techniques for the treatment of breast cancer have significantly evolved,
with advances in conservative and reconstructive techniques.
Novel techniques like skin-sparing mastectomy (SSM) and nipple-sparring mastectomy (NSM) have gained a wider acceptance over radical mastectomy and modified radical mastectomy.
The principles of the NSM are based on the preservation of both the nipple-areola-complex (NAC) and the breast natural skin envelope.
The goals of these techniques (NSM and SSM),
in comparison to radical mastectomies,
are to improve cosmesis and therefore psychological outcomes,
without leaving positive margins of resection nor increasing the risks of locoregional recurrences (1-3). Recent studies demonstrated that NSM had low complication (such as NAC necrosis) and low post-surgical cancer recurrence rates in patients whose tumor did not involve the NAC (1,4).
Most authors recommend NSM in DCIS patients with small tumors (< 3 cm) located more than 2 cm from the NAC,
with negative lymph nodes metastasis (5).
However,
recent studies suggested that patients with even smaller tumor to NAC (tumor-NAC) distance may also benefit from NSM (6).
Preoperative procedures such as digital mammography (DM),
breast ultrasound and MRI have previously been used in detecting the involvement of the NAC (6,7),
in particular by measuring the tumor-to-NAC distance (TND),
in order to choose the best surgical option.
For instance,
Alonzo et al. used MRI to measure the TND in invasive carcinomas,
and concluded that patients with TND ≥ 1 cm could be safely treated with NSM (6),
highlighting that an accurate pre-surgical detection of NAC-involvement is crucial.
The aim of our study was to evaluate the oncological safety and efficiency of NSM in patients with multifocal or extended DCIS and tumor-NAC nearest distance ≥ 1cm measured on MRI,
after a mean follow-up of 40.3 months.