Wesselius, R. (2013) Betrokkenheid van het tepelareolacomplex na ablatio van de mamma bij mammacarcinoom.’. thesis, Medicine.
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Abstract
Introduction: In the Netherlands, carcinoma of the breast is the most common type of cancer in women. There are different options for surgical intervention. Until recently, the nipple-areolar complex has always been removed during mastectomy. A few years ago the nipple-sparing mastectomy has been introduced. However, little is known about the risk of occult nipple involvement in breast tumours and the prognostic factors related to it. Surgeons and pathologists in the Martini Ziekenhuis have the impression that occult nipple involvement occurs less frequently than reported, but there is no data to support this. Aims: The aim of this study was to determine the incidence of nipple-areolacomplex (NAC)-involvement in breast carcinoma after mastectomy and to identify risk factors for NAC-involvement. Secondary aims are to evaluate the concordance of agreement and correlation between pre-operative radiological assessment of the tumour and outcome after pathology. Another aim was to evaluate the success of primary reconstructions and causes of failure. Methods: A retrospective analysis was performed of all patients who underwent a mastectomy for carcinoma of the breast in the Martini Hospital between 01-01-2009 and 31-12-2012. Data were processed in SPSS 20.0. Chi-square analysis was performed for univariate analysis. Only factors that were of significant or clinical importance were included in a binary logistic regression analysis. To estimate the concordance of agreement between radiological and pathological tumour location Cohen’s kappa was used. Spearman’s rho was applicated to evaluate the correlation between radiological size and pathological size. Results: Of 354 performed mastectomies, only 4 showed NAC-involvement after pathology (1.1%). In univariate analysis, tumour location, multifocality and Her2Neu-overexpression were associated with NAC-involvement. Ultrasonography (US) showed the strongest correlation between the size of invasive tumour and radiological assessment. In case of Ductal Carcinoma In Situ (DCIS) mammography (MG) was more accurate. 97 patients underwent primary reconstruction. Mainly as a result of infection, this procedure has been reversed in 17 patients. Smoking and ASA-classification were associated with non-successful primary reconstruction in univariate analysis, whereas in multivariate analysis only smoking was shown to be associated. Conclusion: In this study, the incidence of NAC-involvement is low. Thus, nipple-sparing mastectomy (NSM) might be save in this population. However, a prospective study with a clear definition of NAC-involvement is necessary to give a definitive answer whether NSM is a safe procedure in selected patients. Ultrasound seems to be the most reliable tool to describe the size of invasive tumour. For describing the size of DCIS, this applies for mammography. Almost 1 out of 5 primary reconstructions are not successful. Smoking plays an important role.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kelder, dr. W. and Martini Ziekenhuis, Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/355 |
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