GUIDE TO THE FREQUENCY OF NIPPLE INVOLVEMENT IN BREAST-CANCER - STUDY OF 149 CONSECUTIVE MASTECTOMIES USING A SERIAL SUBGROSS AND CORRELATED RADIOGRAPHIC TECHNIQUE

Based on a serial subgross and correlated radiographic examination technique, the frequency of carcinomatous involvement of the nipple was found to be 30.2 per cent in a consecutive series of 149 mastectomy specimens. This is significantly higher than that in other reported series. Carcinomatous nipple changes in this series were equally divided between invasive and noninvasive types. The most common type of noninvasive cancer found was subclinical, microscopic pagetoid involvement of a lactiferous duct and associated microscopic Paget's disease of the skin of the nipple. Of the nipples with invasive carcinoma, 95.4 per cent were associated with primary tumors less than 25 mm from the nipple. Invasive nipples were more likely to be associated with primary tumors that were poorly differentiated, greater than 20 mm in diameter, and contained axillary metastases than were benign or noninvasive nipples. Fifty per cent of nipples with invasive changes had macroscopic clinical abnormalities. There appeared to be no way to predict the presence of noninvasive carcinomatous involvement of a nipple other than by thorough direct sampling. The associated primary tumor locations were evenly distributed, and only 4.3 per cent of nipples involved with noninvasive cancer were clinically evident. However, removal of the nipple per se and skeletonization of the remaining areola would virtually eliminate the chance of residual noninvasive carcinoma. The higher incidence of nipple-areolar involvement in breast carcinoma found in this series compared to previous reports probably reflects the sampling technique. These data should be considered when approaching the problem of mastectomy and potential reconstruction for carcinoma of the breast. They are not to be interpreted to mean that the investigators are advocates of the procedure. © 1979.