Avaliação dos fatores preditivos de invasão neoplásica do complexo areolomamilar em pacientes com câncer de mama Evaluation of the predictive factors involved in the neoplastic invasion of the nipple-areolar complex in patients with breast cancer

Abstract

INTRODUÇÃO: A escolha pela mastectomia com preservação do complexo areolomamilar (CAM), de melhor resultado estético, depende da ausência de envolvimento neoplásico do CAM. OBJETIVO: Identificar os fatores preditivos de invasão neoplásica do CAM. MÉTODO: Foi realizado estudo analítico, retrospectivo, clínico-patológico de 48 peças de mastectomia de pacientes portadoras de carcinoma da mama, atendidas no Hospital de Câncer da Paraíba - Fundação Napoleão Laureano, durante o período de abril de 2007 a janeiro de 2008, com idade média de 52,69 ± 10,72 anos. O CAM foi seccionado separadamente mediante cortes perpendiculares e paralelos a partir da papila, estendendo-se a 2 cm de profundidade do tecido retroareolar (com o intuito de incluir seios lactíferos e ductos coletores e segmentares), seguidos de cortes transversais até a base. RESULTADOS: Identificou-se frequência de envolvimento do CAM por carcinoma invasivo em 14,58% dos casos. Pacientes jovens (média 42,3 ± 4,7 anos), distância do tumor a mamilo/aréola INTRODUCTION: The choice for having mastectomy with preservation of the nipple-areolar complex (NAC), with better esthetic results, depends on the abscence of neoplastic invasion of the NAC. OBJECTIVE: To identify the predictive factors related to neoplastic NAC invasion. METHODS: We carried out a retrospective, analytical and clinical-pathologic study comprising 48 mastectomy specimens of breast carcinoma from patients treated at Cancer Institute of Paraíba - Napoleão Laureano Foundation (Hospital de Câncer da Paraíba - Fundação Napoleão Laureano) from April 2007 to January 2008. The mean age was 52.69 ± 10.72. The NAC complex was sectioned separately and perpendicular and parallel cuts were performed from the papilla extending 2 cm deep into the retroareolar tissue (including collecting ducts, lactiferous sinuses and segmental ducts), followed by transverse cuts toward the deep margin. RESULTS: The frequency of NAC involvement by invasive carcinoma was 14.58%. The following characteristics were associated with a higher risk of NAC involvement (p < 0.05): younger patients (mean age 42.3 ± 4.7 years), distance between the tumor and the areola/nipple < 2 cm, size of the areola < 3 cm, histological type (invasive ductal carcinoma associated with comedo type ductal carcinoma in situ), status of axillary lymph nodes (mainly with metastasis in 10 or more lymph nodes), presence of lymphovascular and perineural invasion, and inflammatory infiltrate of intra/peritumoral stroma. Smaller areolas correlated significantly with decreased breast weights (p < 0.0016), which demonstrated that the breast size had a greater impact on NAC involvement in comparison with the tumor diameter. CONCLUSION: The results of this study enabled us to identify factors associated with an increased risk of neoplastic NAC invasion.

Keywords

• Mama
• Carcinoma
• Mamilos
• Breast
• Carcinoma
• Nipple