检索历史 清除

目的:探讨中央区乳腺癌乳头乳晕复合体(NAC)的外科处理策略。方法:回顾性分析2017年12月至2020年12月于首都医科大学附属北京同仁医院接受手术的164例中央区乳腺癌的临床病理资料。术前采用影像学检查测量肿瘤边缘至乳头最近距离(TND)、肿瘤长径，记录是否存在乳头内陷、乳头溢液、乳头破溃(包括乳头Paget′s病)等情况。TND≥0.5 cm、无NAC受侵征象(乳头内陷、乳头破溃)且术中冰冻病理示NAC切缘阴性者保留NAC；对于存在NAC受累征象或TND<0.5 cm以及术中冰冻病理证实NAC基底切缘阳性者均切除NAC。影响因素分析采用 χ2检验或Fisher精确检验。 结果:164例中央区乳腺癌患者中，保乳手术(保乳组)73例，保留乳头乳晕复合体乳房切除术(NSM组)43例，乳房全切术(乳房全切组)34例，保留皮肤乳房切除术(SSM组)14例。58例患者行NAC切除(乳房全切组34例，SSM组14例，保乳组10例)，病理证实NAC受侵25例(乳房全切组12例，SSM组9例，保乳组4例)。TND( P＝0.040)、乳头内陷( P＝0.031)与NAC受累有关，TND<0.5 cm时NAC受累及的可能性更高( P＝0.014)；肿瘤大小( P＝0.519)、淋巴结转移( P＝0.847)、血性乳头溢液( P＝0.742)与NAC受侵无关。全组患者随访12~48个月，局部复发1例，远处转移3例。 结论:对于中央区乳腺癌患者，TND≥0.5 cm、无NAC受侵征象(乳头内陷、乳头破溃)且术中冰冻病理NAC切缘阴性者可以采用保留NAC的手术，而对于TND<0.5 cm或伴有NAC受侵征象时应切除NAC，同时可以选择乳头重建以改善中央区乳腺癌患者的术后外形。

Objective:To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer.Methods:A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget′s disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ2 test or Fisher exact test was used to analyze the influencing factors. Results:Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND ( P=0.040) and nipple invagination ( P=0.031). There were no correlations between tumor size ( P=0.519), lymph node metastasis ( P=0.847), bloody nipple discharge ( P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions:For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.