title: A comparison of clinical and pathologic assessments for the prediction of occult nipple involvement in nipple-sparing mastectomies.
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) for both risk reduction and cancer is increasing. In the cancer setting, most studies suggest the use of both clinical and intraoperative biopsy criteria in patient selection. This study examines the use of both biopsy and clinical criteria in women undergoing total nipple-removing mastectomy.
  
  
  METHODS
  The study consisted of 58 patients undergoing total mastectomy without nipple sparing. Biopsies of the subareola tissue (SA), proximal nipple (NC) contents and radial sections of the residual nipple (NR) were examined microscopically. Tumor size and distance from the nipple were also noted.
  
  
  RESULTS
  Using clinical criteria alone, the false negative rate was 53.8% and a false positive rate of 44.4%. When adding subareola and nipple core biopsies to clinical criteria the false negative rate fell to 7.7% but the false positive rate remained at 44.4%. When using only SA and NC biopsies to predict occult nipple involvement, the false negative rate was 11.8%. In 4 cases the NC was positive while the SA was negative for cancer and in 6 cases the SA was positive and NC negative. In 2 cases both the NC and SA biopsies were negative while the NR was positive.
  
  
  CONCLUSIONS
  This study supports a more limited role in the use of clinical criteria for evaluating patients for NSM. This maximizes the number of patients who are candidates for NSM with minimal risk of nipple involvement. It was also noted that intraoperative biopsies are not totally reliable in predicting occult nipple involvement.
authors.affiliation: Department of Surgery, Tulane University Medical Center, 1717 St. Charles Ave, New Orleans, LA, USA. alanstolier1@gmail.com
authors.forename: Alan
authors.initials: A
authors.lastname: Stolier
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Stone
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Moroz
authors.forename: Cynthia W
authors.initials: CW
authors.lastname: Hanemann
authors.forename: Leslee
authors.initials: L
authors.lastname: McNabb
authors.forename: Steven D
authors.initials: SD
authors.lastname: Jones
authors.forename: Michelle
authors.initials: M
authors.lastname: Lacey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009558:Nipples / Q000473:pathology*; D059351:Organ Sparing Treatments; D018579:Patient Selection; D011237:Predictive Value of Tests