Development and validation of a model predictive of occult nipple involvement in women undergoing mastectomy
- 9 October 2008
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 95 (11), 1356-1361
- https://doi.org/10.1002/bjs.6349
Abstract
Background: This prospective study aimed to build a predictive model using preoperative information to aid selection for nipple‐sparing mastectomy. Methods: Two hundred consecutive skin‐sparing mastectomy specimens without overt nipple involvement were evaluated. Demographic, preoperative pathology and imaging information was collected. Nipple specimens (2 × 2 × 2 cm) were sectioned at 3‐mm intervals. Haematoxylin and eosin‐stained slides were examined by a breast pathologist for involvement by tumour. Logistic regression analyses of 65 therapeutic procedures identified factors associated with occult involvement and created a predictive model. This was tested on specimens from a further 65 therapeutic procedures. Results: Occult nipple involvement was noted in 32 (24·6 per cent) of 130 mastectomy specimens. In the training set, imaging diameter of the lesion and its distance from the nipple predicted nipple involvement on univariable analysis (P = 0·011 and P = 0·014 respectively). The multivariable logistic regression model was validated in the test set. The areas under the receiver–operating characteristic curve were 0·824 and 0·709 for the training and test sets respectively. Conclusion: Three‐quarters of women undergoing mastectomy did not have occult nipple involvement. A clinical tool including tumour size and distance from the nipple has been developed to improve patient selection for nipple‐sparing mastectomy. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.Keywords
This publication has 27 references indexed in Scilit:
- Breast Reconstruction following Subcutaneous Mastectomy for Cancer: A Critical Appraisal of the Nipple-Areola ComplexPlastic and Reconstructive Surgery, 2006
- Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancerThe American Journal of Surgery, 2005
- Skin-sparing mastectomyThe American Journal of Surgery, 2004
- Bilateral Prophylactic Mastectomy Reduces Breast Cancer Risk in BRCA1 and BRCA2 Mutation Carriers: The PROSE Study GroupJournal of Clinical Oncology, 2004
- Skin-Sparing Mastectomy with Conservation of the Nipple–Areola Complex and Autologous Reconstruction is an Oncologically Safe ProcedureAnnals of Surgery, 2003
- Nipple-Areola Reconstruction: Satisfaction and Clinical DeterminantsPlastic and Reconstructive Surgery, 2002
- Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trialThe Lancet, 2002
- Medical Contraindications Are Not a Major Factor in the Underutilization of Breast Conserving TherapyJournal of the American College of Surgeons, 1998
- Skin-Sparing MastectomyAnnals of Surgery, 1997
- Modified Skin Incisions for MastectomyPlastic and Reconstructive Surgery, 1991