乳腺癌乳头乳晕复合体受侵犯的相关临床病理因素

The clinicopathologic factors associated with nipple-areola complex involvement in breast cancer

保留乳头乳晕复合体(nipple areola complex,NAC)的乳房切除术(nipple-areola complexsparing mastectomy,NSM)是传统的乳腺切除手术的一种改进术式,能完整切除肿瘤并最大限度保持乳房外形美观。目前有关NSM仍存在许多尚待解决的问题,其中一个重要问题就是如何在术前选择合适的患者。许多肿瘤的临床病理特征,如肿瘤到乳头的距离(tumor-to-nipple distance,TND)和肿瘤位置、肿瘤大小、多中心性肿瘤、淋巴结转移和脉管侵犯、组织学分级、HER-2表达情况等与NAC隐匿性的肿瘤累及率密切相关,但如何在NSM术前对这些指标进行精确评估仍需进一步探索。临床评估NAC有无异常,NAC后方乳腺组织的病理评估,并综合分析与NAC累及相关的临床病理因素是目前用于判断乳腺癌患者是否可行NSM的主要方法。更多的大规模临床研究仍需进行,以利于制定统一的NSM患者选择标准。

Nipple-areola complex-sparing mastectomy （NSM） is a surgical procedure that allows the preservation of the skin and nipple-areola complex （NAC） in mastectomy. The use of NSM for breast cancer is still controversial. The appropriate standard for selecting patients with low risk of NAC involvement has not been well established. The clinicopathologicity characteristics of primary tumor （e.g., tumor-to-nipple distance, tumor location, tumor size, multicentricity, lymph node metastasis, lymphovascular invasion, grade, HER-2 status） have been reported to be associated with NAC involvement. Clinical evaluation of NAC, retroareolar tissue biopsy and evaluation ofclinicopathologic characteristics of primary tumor are helpful to patient selection in current clinical practice of NSM. Further studies are still needed to establish uniform selection criteria for NSM in breast cancer patients.