AvaliaÃÃo dos fatores preditivos de invasÃo neoplÃsica do complexo arÃolo-mamilar em pacientes com cÃncer de mama

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

A retrospective study was carried out in order to identify the predictive factors involved in the neoplastic invasion of the nipple-areolar complex (NAC), in patients with breast cancer. The clinico-pathologic characteristics of 48 patients with a diagnosis of breast carcinoma seen at Hospital de CÃncer da ParaÃba â FundaÃÃo NapoleÃo Laureano, from April 2007 to January 2008, were evaluated. The mean age was 52.69 Â10.72, varying from 34 to 74 years old. The pathologic examination of mastectomy specimens was performed according to the model proposed by the Brazilian Pathology Society (2005), in addition to a more detailed examination of the NAC. The NAC was sectioned separately, including the entire retro-areolar glandular tissue, from the nipple to the deep/fascial margin. The lateral, medial, superior and inferior NAC âmarginsâ corresponded to the entire circumference of the areola with an additional 0.5 cm of tissue measured from the areolar contour. A series of perpendicular cuts was performed from the nipple extending 2.0 cm deep (to include collecting ducts, lactiferous sinuses and segmentary ducts), followed by transverse cuts down to the level of the deep margin. The distance between the sections was approximately 2.0 mm. The frequency of involvement of the NAC by invasive carcinoma was 14.58%. The following variables were evaluated: age, side, location of the tumor, tumor size, histologic type, histologic grade, size of the areola, size of the nipple, breast weight, distance from tumor to areola and nipple, axillary lymph node status, number of positive nodes, presence of peritumoral inflammatory infiltrate, presence of lymphovascular and perineural invasion, and TNM stage. Younger patients (mean 42.3 Â 4.7 years), distance between tumor and areola/nipple 2.0 cm, size of the areola 3.0 cm, ductal type in association with comedo ductal carcinoma in situ (DCIS), metastases to axillary lymph nodes (especially to 10 or more), presence of lymphovascular and perineural invasion, and intra and peritumoral inflammatory infiltrate were associated with an increased risk for NAC involvement (p<0.05). Smaller areolas correlated with decreased breast weights (p<0,0016), which indicated that the size of the breast had a greater impact on the involvement of the NAC, than did size of the tumor. Multivariate analysis and logistic regression showed that the most important parameters were number of positive axillary nodes and the presence of comedo type DCIS. This study helped identify factors associated with an increased risk for NAC involvement by invasive breast carcinoma, contributing to the selection of patients who may be potential candidates for surgical preservation of the NAC

ASSUNTO(S)

mamilo mama carcinoma breast anatomia patologica e patologia clinica nipple carcinoma

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