The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients

BACKGROUND: The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. METHODS: We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. RESULTS: Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, chi251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, chi211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues. CONCLUSIONS: Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases

El impacto de la citología maligna de descarga del pezón (NDc) en el tratamiento quirúrgico de pacientes con cáncer de mama

Background The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. Methods We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. Results Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, ?2 51.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, ?2 11.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues. Conclusions Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases

Axillary lymph nodes management in breast cancer patients US: ultrasound; FNA: fine needle aspiration; SLN: sentinel lymph node; ITC: isolated tumour cells.

<p>Axillary lymph nodes management in breast cancer patients US: ultrasound; FNA: fine needle aspiration; SLN: sentinel lymph node; ITC: isolated tumour cells.</p

Metastatic involvement of the axilla in 154 breast cancer patients that underwent US-guided FNA.

<p>Legend: US: Ultrasonography; FNA: Fine-Needle Aspiration cytology; ALND: Axillary Lymph Node Dissection; SLN: Sentinel Lymph Node.</p><p>Metastatic involvement of the axilla in 154 breast cancer patients that underwent US-guided FNA.</p

Number of axillary metastatic lymph nodes in breast cancer patients with positive (micro- and macrometastases) sentinel lymph nodes (SLNs) and in patients with positive ultrasound (US) guided fine needle aspiration cytology (FNA).

<p>The percentage of cases with >3 axillary metastatic lymph nodes is higher in patients with positive US-guided FNA cytology than in patients with metastatic SLNs.</p

Status of axillary lymph nodes in 365 breast cancer patients with positive US-guided FNA or positive SLN.

<p>Legend: SLN: Sentinel Lymph Node; US: Ultrasonography; FNA: Fine-Needle Aspiration cytology. MTS: metastases; ALND: axillary lymph node dissection; LN: lymph node.</p><p>*Including SLN.</p><p>Status of axillary lymph nodes in 365 breast cancer patients with positive US-guided FNA or positive SLN.</p

Clinical and histopathological characteristics of 1287 breast cancer patients who underwent axillary US examination.

<p>Legend: SLN: Sentinel Lymph Node; ITC: Isolated Tumour Cells.</p><p>Clinical and histopathological characteristics of 1287 breast cancer patients who underwent axillary US examination.</p

Pathology data of the malignant breast lesions of patients who underwent nipple-areola complex (NAC) amputation.

<p>Pathology data of the malignant breast lesions of patients who underwent nipple-areola complex (NAC) amputation.</p

HER2 expression in BC cell lines.

<p>Immunohistochemistry for MCF7 (A) and BT474 (B) cells.</p

Giemsa staining & ICC.

<p>Giemsa staining on ND smear (A) and on the corresponding DCIS (B). HER2 ICC expression of the malignant cells on ND smear (C) and on the corresponding DCIS (D).</p