title: Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer.
abstract: BACKGROUND
  Proper patient selection is important for nipple-sparing mastectomy, and we aimed to identify preoperative factors predictive of pathologic nipple-areola complex (NAC) involvement to assist with surgical planning.
  
  
  METHODS
  We retrospectively reviewed a prospectively collected database of patients who underwent mastectomy for DCIS or invasive breast cancer at a single institution. Cases with NAC involvement, NAC(+), were compared with those without NAC involvement, NAC(-). Multivariate logistic regression analysis was performed to determine preoperative factors independently predictive of NAC involvement.
  
  
  RESULTS
  A total of 238 standard, 107 skin-sparing, and 47 nipple-sparing mastectomies were performed, and the NAC was pathologically involved in 16% (N = 62). Clinical NAC involvement, as determined by patient symptoms or physical exam, was present in 61% of NAC(+) but only 14% of NAC(-) cases (P < .0001) and carried a 92% negative predictive value (NPV). Preoperative imaging involved the NAC in 38% of NAC(+) but only 4% of NAC(-) cases (P < .0001) and carried an 89% NPV. NAC(+) tumors were larger, with mean size 3.3 cm versus 2.5 cm for NAC(-) tumors (P = .024). The mean tumor-to-nipple distance was 2.0 cm for NAC(+) versus 4.7 cm for NAC(-) tumors (P < .0001). On multivariate analysis, independent predictors of NAC involvement were the presence of clinical NAC involvement (odds ratio [OR] 5.11, 95% confidence interval [95% CI] 2.53-10.35) and imaging involvement of the NAC (OR 5.82, 95% CI 2.43-13.94).
  
  
  CONCLUSIONS
  Clinical and imaging abnormalities at the NAC are the only independent preoperative predictors of NAC pathology, and the absence of these factors conveys a low probability of NAC involvement.
authors.affiliation: Department of General Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
authors.forename: Julie A Y
authors.initials: JA
authors.lastname: Billar
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult