Prediction of occult nipple-areola complex involvement in breast cancer patients

The aim of this study was to evaluate predictive factors for the nipple-areola complex (NAC) involvement, and to define a subgroup of patients who may benefit from skin-sparing mastectomy with the NAC preservation in breast cancer patients. Univariate and multivariate analyses were carried out in the retrospective data of 397 eligible patients. The NAC involvement was histopathologically proved in 59 (14.6%) of the patients. In the multivariate logistic regression analysis showed that tumor location (central vs peripheral; p<0.0001 hazard ratio [HR], 7.5; 95% confidence interval [CI], 3.4-14.6), number of positive axillary lymph nodes (>= 10 vs < 10; p<0.005 HR, 2.9 CI, 1.3-6.1) and lymphatic vascular invasion (yes vs no; p<0.0001 HR, 3.5; CI, 1.7-7.1) were the most important prognostic factors. Whereas patients with 2 or 3 risk factors were accepted as high-risk group for the NAC involvement, those with no or 1 risk factor was defined as low-risk group. These groups had a 50.0% NAC involvement rate and a 8.1% NAC involvement rate, respectively (p<0.0001). In conclusion, this study showed that patients with 2 or 3 predictive factors had a high risk of the NAC involvement. These risk factors should be taken into consideration in patient selection for skin-sparing mastectomy with the NAC preservation.