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PubMed2001

APACC, a French prospective study on aspirin efficacy in reducing colorectal adenoma recurrence: design and baseline findings.

UNLABELLED: Colorectal cancer is the second most frequent cause of death from cancer in western countries. Many lines of evidence suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may offer chemoprevention against colorectal cancer. A multicentre, double-blind, randomized, controlled trial is underway to determine the efficacy of regular aspirin intake (160 or 300 mg/day) in reducing colorectal adenoma recurrence. We now report the baseline characteristics of subjects enrolled into the trial. RESULTS: A total of 618 polyps were excised from 274 patients at the baseline colonoscopy. Men had on average (+/-SD) 2.5 +/- 1.8 polyps per subject and women had 1.7 +/- 1.2. Ninety-one (33.7%) had three or more adenomas and 183 (67.8%) had more than one adenoma measuring 10 mm or more in diameter. The mean (+/-SD) age of the subjects was 57.7 (+/- 9.4) years. Sixty-seven (24.9%) reported that they had previously had adenoma(s), 95 (35.2%) reported a family history of colorectal cancer and 41 (15.2%) a family history of colorectal adenomas. PERSPECTIVE: All subjects will undergo a one-year clearance colonoscopy by February 2001. Clinical, molecular biological and dietary data will enable us to investigate other factors influencing the recurrence of adenomas in this group of high-risk subjects.

Adenoma↗
PubMed1987

[Preventive value of intravesical thiotepa on the recurrence of Ta-T1 vesical tumors treated by conservative surgery. Apropos of 247 cases a mean follow-up of 88 months].

The retrospective homogeneous study of 247 patients with follow-up from 12 months to 384 months (mean 88 months) and managed with or without intra-vesical instillations of thiotepa as prophylactic chemotherapy after surgical conservative treatment is compared with some literature's data principally multicentric randomized series. Statistics contradictions remain with no significative results for possible progression towards infiltration, better "free interval" between recurrences, and better recurrence rate for 100 patients/months. In this series the number of tumors recurrences in each bladder was evaluated: this mean rate of tumors recurrences/year is 1,7 without prophylactic thiotepa and only but always 1,08 with thiotepa. Prophylactic instillations chemoprophylaxy seems to be justified but must be emphasized: mitomycin C, BCG therapy would be better in the future?

Administration, Intravesical↗
PubMed2000

The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. The DURAC Trial Study Group.

OBJECTIVES: To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. DESIGN: An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. SETTING: Sixteen hospitals in central Sweden. SUBJECTS: A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. MAIN OUTCOME MEASURES: Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. RESULTS: A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (+/-SD) period of 31(+/-29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4-1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. CONCLUSIONS: The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis.

Aged↗
PubMed2003

Oral ximelagatran for secondary prophylaxis after myocardial infarction: the ESTEEM randomised controlled trial.

BACKGROUND: Despite important advances in treatment, the risk of recurrent ischaemic events is high both early and late after an acute coronary syndrome. We aimed to assess the effectiveness of ximelagatran and acetylsalicylic acid for prevention of death, non-fatal myocardial infarction, and severe recurrent ischaemia after a recent myocardial infarction. METHODS: In this placebo-controlled, double-blind, multicentre, multinational dose-guiding study we assessed 1883 patients who had had recent ST-elevation or non-ST-elevation myocardial infarction. Within 14 days after the index event we randomised the participants in the proportions 1/1/1/1/2 to oral ximelagatran at doses of 24 mg, 36 mg, 48 mg, or 60 mg twice daily, or placebo, respectively for 6 months. All patients received acetylsalicylic acid 160 mg once daily. The primary efficacy outcome was the dose response of ximelagatran by comparison with placebo for the occurrence of all-cause death, non-fatal myocardial infarction, and severe recurrent ischaemia. Analysis was by intention to treat. FINDINGS: Oral ximelagatran significantly reduced the risk for the primary endpoint compared with placebo from 16.3% (102 of 638) to 12.7% (154 of 1245) (hazard ratio 0.76, 95% CI 0.59-0.98, p=0.036) for the combined ximelagatran groups versus placebo. There was no indication of a dose response between the ximelagatran groups. Major bleeding events were rare, 1.8% (23 of 1245) and 0.9% (six of 638) (hazard ratio 1.97, 95% CI 0.80-4.84) in the combined ximelagatran and placebo groups, respectively. We recorded no serious clinically adverse outcomes judged related to the investigational drug. INTERPRETATION: Oral direct thrombin inhibition with ximelagatran and acetylsalicylic acid is more effective than acetylsalicylic acid alone in preventing major cardiovascular events during 6 months of treatment in patients who have had a recent myocardial infarction.

Administration, Oral↗
PubMed2002

Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial.

BACKGROUND: Patients who undergo endoscopic sphincterotomy for common bile-duct stones, who have residual gallbladder stones, are referred for laparoscopic cholecystectomy. However, only 10% of patients who do not have this operation are reported to develop recurrent biliary symptoms. We aimed to assess whether a wait-and-see policy is justified. METHODS: We did a prospective, randomised, multicentre trial in 120 patients (age 18-80 years) who underwent endoscopic sphincterotomy and stone extraction, with proven gallbladder stones. Patients were randomly allocated to wait and see (n=64) or laparoscopic cholecystectomy (56). Primary outcome was recurrence of at least one biliary event during 2-year follow-up, and secondary outcomes were complications of cholecystectomy and quality of life. Analysis was by intention to treat. FINDINGS: 12 patients were lost to follow-up immediately. Of 59 patients allocated to wait and see, 27 (47%) had recurrent biliary symptoms compared with one (2%) of 49 patients after laparoscopic cholecystectomy (relative risk 22.42, 95% CI 3.16-159.14, p<0.0001). 22 (81%) of 27 patients underwent cholecystectomy, mainly for biliary pain (n=13) or acute cholecystitis (7). Conversion rate to open surgery was 55% in patients allocated to wait and see who underwent cholecystectomy compared with 23% in those who were allocated laparoscopic cholecystectomy (p=0.0104). Morbidity was 32% versus 14% (p=0.1048), and median hospital stay was 9 versus 7 days. Quality of life returned to normal within 3 months after either treatment policy. INTERPRETATION: A wait-and-see policy after endoscopic sphincterotomy in combined cholecystodocholithiasis cannot be recommended as standard treatment, since 47% of expectantly managed patients developed at least one recurrent biliary event and 37% needed cholecystectomy. No major biliary complications arose, but conversion rate was high.

Adult↗
PubMed2004

Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors.

BACKGROUND: Randomized trials comparing neoadjuvant versus adjuvant chemotherapy show that primary chemotherapy allows more frequent breast-preserving surgery even though no survival advantage has been demonstrated. The aim of the current study was to determine the predicting factors and the survival impact of breast conservation in patients with large breast tumors treated with neoadjuvant chemotherapy. METHODS: Between January 1987 and December 2001, 594 patients with invasive T2-3 breast carcinoma who were ineligible for breast-conserving surgery (the mean initial tumor diameter was 49 mm) were treated with 3 or 4 courses of an anthracycline-based primary chemotherapy, surgery, and radiotherapy. Various clinicopathologic factors were tested as possible predicting factors of breast-preserving surgery. Survival analyses were performed to determine the implications of breast-conserving surgery on outcome. RESULTS: After primary chemotherapy, 287 (48%) patients were eligible for breast-conserving surgery and 307 patients underwent a mastectomy. Initial tumor diameter > 5 cm, low histologic grade, lobular histology, and multicentricity were independent predicting factors of breast conservation ineligibility in the multivariate analysis (logistic regression). In the univariate survival analysis, a failure of breast-preserving surgery was associated with a poor outcome. Local disease recurrence-free survival rates were similar in patients treated with lumpectomy and mastectomy. CONCLUSIONS: The results reported in the current study suggested that initial diameter, histologic type and grade, and multicentricity are potential prechemotherapy predicting factors of breast conservation. When carefully selected, patients treated with breast conservation had a risk of local disease recurrence similar to the risk of chest wall disease recurrence after mastectomy.

Adult↗
PubMed1995

Vulvar intraepithelial neoplasia III: a viral disease of undetermined progressive potential.

Seventy-three patients with vulvar intraepithelial neoplasia (VIN) grade III were followed for a median of 5 years after primary treatment. Thirty women also had a diagnosis of cervical neoplasia. During the follow-up 26 patients (36%) had one or more vulvar recurrences. Recurrences were seen significantly more often in the patients who also had cervical neoplasia, indicating a common etiology. Microinvasive carcinoma developed in 12 patients, 3 of whom later developed frankly invasive vulvar cancer. The original, paraffin-embedded vulvar specimens were examined by the polymerase chain reaction for human papillomavirus DNA of the types HPV 6, 11, 16, 18, and 33. HPV types 16 and 33 were found in 90% of the VIN lesions. It is concluded that VIN III is an HPV-related disease in all or almost all cases, and that a generalized genital HPV infection may be a factor in the development of multicentric genital neoplasia. No association was observed between the specific HPV type and the risk of recurrent vulvar disease, cervical neoplasia, or malignant progression.

Adult↗
PubMed1998

Cost effectiveness of fluvoxamine in the treatment of recurrent depression in France.

OBJECTIVE: The objective of this study was to examine the cost effectiveness of fluvoxamine compared with tricyclic antidepressants (TCAs) in the treatment of patients with depressive episodes. DESIGN AND SETTING: A Markov process model was constructed to model the effectiveness, as measured by time without depression, and the costs of both treatments. The model examined a period of 18 months in order to capture the influence of both relapses and recurrences on the outcomes. Data for the construction of the model came from the published literature, an expert panel and a large multicentre randomised clinical trial. Costs were obtained from published sources. The setting for this study was France. MAIN OUTCOME MEASURES AND RESULTS: The results of the baseline analysis showed that the use of fluvoxamine in the maintenance treatment (recurrence prevention) of depressive disorders was less costly than TCAs with total costs (direct and indirect costs) of 40,232.40 French francs (FF) and FF52,257.53, respectively (1996 values). In addition, due to the prevention of relapse and recurrence, effectiveness favoured fluvoxamine as it was associated with a longer period of time without depression when compared with TCAs (79% of the study period vs 71%). Sensitivity analyses confirmed the robustness of these findings. CONCLUSION: In conclusion, on the basis of the assumptions used in the model, the use of fluvoxamine as maintenance therapy is clinically and economically justified in patients with depressive disorders.

Antidepressive Agents, Second-Generation↗
PubMed1996

Placebo-controlled clinical trial of mesalazine in the prevention of early endoscopic recurrences after resection for Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID).

OBJECTIVE: Endoscopic postoperative recurrences occur early after 'curative' surgery for Crohn's disease. Pentasa has been shown to be effective in the maintenance treatment of quiescent Crohn's disease. The aim of this study was to test the efficacy of a 12-week oral intake of Claversal in the prevention of endoscopic recurrences after 'curative' resection for ileal, colonic or ileocolonic Crohn's disease. We conducted a multicentre double-blind controlled trial comparing Claversal (1g tid) with placebo, starting within 15 days after surgery. The macroscopic normality of the two anastomotic segments was assessed at surgery. Patients were clinically and biologically evaluated twice (6-week interval), and colonoscopy was performed at 12 weeks. Endoscopic relapse was defined by any anastomotic ulcerations or stenosis and staged according to a four-grade score. RESULTS: Between May 1989 and May 1991 12 centres included 126 patients, 70 women and 56 men, aged 33 +/- 12 years (range 16-70) in the study. Disease locations were ileal, colonic and ileocolonic in 45, 6 and 49%, respectively. Claversal and placebo groups were similar at inclusion, except for ESR (37 +/- 26 vs. 27 +/- 23 mm/h in the Claversal and placebo groups, respectively; P < 0.05). Nine patients were withdrawn from the study. Adverse reactions occurred only in six patients. Five patients were excluded for protocol violation. Finally, 106 patients could be evaluated at 12 weeks (55 Claversal and 51 placebo). An endoscopic relapse was observed in 50% and 63% of the Claversal and placebo groups, respectively (P = 0.16), with a similar grade distribution. Claversal was well tolerated. CONCLUSIONS: Our study confirms that a large proportion of endoscopic recurrences occur within 3 months of resection in Crohn's disease. There was a slight trend towards greater efficacy of Claversal; it could be worthwhile trying higher dosages and/or 5-ASA compounds with different intestinal release profiles.

Administration, Oral↗
PubMed1987

Musculoaponeurotic fibromatosis. A report of 28 cases and review of the literature.

Although musculoaponeurotic fibromatosis (MAF) is a well-recognized entity, it still provides a histologic diagnostic enigma, particularly in its distinction from a well-differentiated fibrosarcoma. The lesion is histologically identical to a desmoid tumor. The lesion appears as a firm swelling in a limb or limb girdle, with a rare incidence of pain. Although it is more common in the second to fourth decades (premenopausal women predominantly), it does occur in children. The sex incidence in children is equal. A multicentric pattern of behavior may be evident. The mainstay of treatment has been surgical excision of varying extent. Local excision, even if radical, may be followed by up to a 65% recurrence rate. In this review, 40% of the cases had more than one recurrence. Recent evidence suggests radiotherapy, which has been reserved for inoperable lesions, may be of value as an adjunct to primary treatment. Limited local excision with adjunctive radiotherapy may decrease recurrence rate, minimize functional deficit, and improve cosmesis. Radical local resection (compartmental or amputation) may be avoidable. In children, amputation may not result in cure because of the multicentric behavior pattern and radiotherapy may lead to growth retardation. A shorter functional upper or lower limb is preferable to an amputation stump or a limb disfigured from radical excision.

Adolescent↗
PubMed1995

Surgical treatment of extra-abdominal desmoid tumours (aggressive fibromatoses).

Extra-abdominal desmoid tumours (EADT) are benign lesions but difficult to cure because of their infiltrative nature and tendency to recur. Among many treatments recommended in the past, wide excision has been successful, even in difficult cases. We have analyzed retrospectively 41 cases of histologically confirmed EADTs. A total of 98 operations were performed on these patients: 29 wide excisions on 22 patients, 52 intra-lesional excisions with wide margins on 16 patients, and 17 incomplete excisions on 3 patients. One patient, with intra-pelvic lesions, died of a massive haemorrhage 3 days after surgery. Forty patients were followed from between 3 and 29 years. One, who had a multicentric EADT for 21 years, died from the disease. The significant factors concerning local recurrence after wide procedures were an unsatisfactory initial wide local excision, disease affecting 4 or more muscles and the invasive nature of the recurrences. We recommend wide local excision of these tumours in all anatomical areas that allow this procedure. When major nerves and vessels are involved, we recommend an intralesional excision with wide margins in order to preserve limb function. Radiation therapy should be confined to cases in which wide local procedures are not feasible. Overall, 37 of our patients (90%) were cured of the disease, 2 had their disease controlled, and 2 died.

Adolescent↗
PubMed2003

[Premedication by thienopyridine before percutaneous coronary interventions in unstable angina].

Ticlopidine or clopidogrel combined with aspirin decrease major cardiac events (Mace) after PTCA with stent implantation. It has not be proven yet that pretreatment by T or C was superior to conventional post-treatment, especially in unstable patients. The aim of the present study was to determine the influence of thienopyridine pretreatment on the risk of Mace (death, Q wave myocardial infarction, need for repeat PTCA or surgery, angina recurrence, stent thrombosis) during the hospitalization period in a population prospectively included in 2 multicentre registries of patients undergoing placement of a S670 or S7 stent (Medtronic) implanted in native coronary arteries (> or = 3.0 mm). Among the 2929 patients included into the registries, 1205 had unstable angina (41%). 50.2% of the patients were pretreated by T or C (T = 15.7%, C = 34.5%); 85.5% received aspirin before the procedure; definition of pretreatment was the administration of drug at least 6 hours before stent implantation. GPIIb-IIIa antagonists were administered in only 13.9% of patients. Mace were observed in 2% of the patients. Factors correlated with Mace by univariate and multivariate analyses were: age > 73 years (RR: 2.37; 95% CI: 1.05-5.36, P < 0.037), previous myocardial infarction (RR: 2.56; 95% CI: 1.08-6.11, P < 0.034), pretreatment by T or C (RR: 0.389; 95% CI: 0.16-0.95, P < 0.038). In patients who did not receive GPIIb-IIIa antagonists, age > 73, and pretreatment by T or C were the only independent predictors of Mace.

Aged↗
PubMed1990

A case of multiple thymoma: the possibility of intra-thymic metastasis.

A case of multiple thymoma is reported. The patient was a 28-year-old woman who came to us with myasthenia gravis. There were two separate thymoma in the anterior mediastinum: one measured 70 x 30 x 30 mm, while the other was 1.5 mm in diameter and situated in the surrounding thymic tissue. A histological study revealed that both thymoma consisted of epithelial cells with abundant cytoplasm, round-to-oval nuclei and inconspicuous nucleoli. Morphometric analysis showed the nuclear size of the epithelial cells to be similar in both tumors. The likelihood of positive Leu7 and keratin immunohistochemical staining was also similar for the two tumors. The two thymoma had similar histological, morphometric and immunohistochemical characteristics. These findings suggest the possibility of intra-thymic metastasis rather than a multicentric thymoma development. Extended thymectomy should be performed for thymoma to prevent postoperative tumor recurrence.

Adult↗
PubMedDate not supplied

Local recurrence of breast cancer after skin-sparing mastectomy following core needle biopsy: case reports and review of the literature.

The latest advances in diagnostic and therapeutic procedures for breast cancer have provided valuable technological breakthroughs. Yet the long-term consequences of these modern methods are still quite unclear. Such is the case for stereotactic or ultrasound-guided histologic needle biopsy and skin-sparing mastectomy. We report on three patients who presented with multicentric breast cancer diagnosed by stereotactic needle biopsy and treated by skin-sparing mastectomy. All three patients developed recurrence at the core needle entry site. Records of 58 patients with breast cancer who were treated by skin-sparing mastectomy followed by immediate reconstruction (with transverse rectus abdominis muscle [TRAM] flap or tissue expander) at the Breast Diseases Division of Buenos Aires British Hospital between December 1999 and December 2003 were reviewed retrospectively. Eleven of these patients were diagnosed by histologic needle biopsy. The mean follow-up was 28 months (range 5-60 months). Three (skin or subcutaneous) local recurrences at the needle entry site, diagnosed in a mean time of 23.6 months (16, 22, and 23 months), were reported. The three patients underwent complete resection with clear margins, radiation therapy to the "neobreast," and tamoxifen. All three patients are disease free with a mean postrecurrence follow-up of 24.3 months (30, 23, and 22 months). Based on the evidence of displacement of tumor cells and the potential nonresection of such tumor seeding at the time of skin-sparing mastectomy, as well as the poor probability of postoperative radiation therapy, we recommend surgical resection of the needle biopsy tract, including the dermal entry site, at the time of mastectomy.

Adult↗
PubMed1997

[Conservative treatment of renal cell carcinoma: framework, incidence and classification].

Recent interest in nephron sparing surgery for renal cell carcinoma has been stimulated by advances in diagnostic imaging, following an increasing number of incidentally discovered low stage renal cell carcinoma and good long term survival in patients undergoing this form of treatment. Tosaka et al reported a 5-years survival of 94.7% in patients with incidental renal cell carcinoma compared with 60.9% in diagnosed because symptomatic. Along with a diagnosis of carcinoma more and more premature, a whole string of little lesions is present, not easily identifiable by the recent diagnostic imaging. Tosaka and others examined renal lesions going by the ultrasonography as a check-up or as a first frame in patients suffering from microscopic hematuria; they proved that neoplastic lesions represent 5.4% of all the masses identifiable by diagnostic imaging. The frequent discovery of limited carcinoma, the difficulty in the diagnostic attribution and demonstration of the good survival of patients who were treated by a nephron sparing surgery, added to the one of patients undergone to radical nephrectomy, caused an interest in nephron-sparing surgery for incidental renal carcinoma also for patients with normal controlateral kidney and not very extended tumors, usually in peripheral sites. At the moment record of cases concerning nephron sparing surgery is quite limited, any way it shows a survival equal to 90% with only two local recurrences, reported only in one experience and caused by an incomplete resection or by multicentric neoplastic lesions.

Carcinoma, Renal Cell↗
PubMed2002

Long-term follow-up of patients with conjunctival melanoma.

Data from long-term follow-up examinations of patients with conjunctival melanoma are limited. A retrospective study of survival rates and local tumor relapse rates was performed on 85 patients initially treated between 1958 and 1993. Therapeutic procedures were local excision, local excision followed by brachytherapy, local excision combined with cryotherapy, and local excision followed by either irradiation or cryotherapy and adjuvant mitomycin C (MMC) application. The Kaplan-Meier method was used to estimate cumulative survival rates and event rate curves. Clinical parameters of the patients and the tumors were obtained and analyzed for their relation to tumor recurrence and death from metastatic melanoma using the multivariate Cox hazards modeling. The median follow-up duration among the surviving patients was 13.1 years (mean 13.8 years). The cumulative 10-year survival rate of the 85 patients based on all causes of death was 62.5%, and that based on tumor-related death was 77.7%. Patient age greater than 55 years, higher TNM category, and unfavorable tumor location (palpebral conjunctiva, fornix, caruncle, corneal stroma, eyelid) were identified as prognostic factors for death from metastatic melanoma. Tumors with unfavorable location, higher TNM grade, and excision alone as initial therapy showed a higher cumulative probability of local relapse than favorably located (bulbar and limbal conjunctiva) tumors, lower TNM grade, and excision plus adjuvant therapy. The behavior of conjunctival melanomas remains unpredictable in individual cases. To minimize local recurrence rate surgical excision should be combined with an adjunctive procedure such as irradiation, cryotherapy, or local chemotherapy with MMC. Randomized prospective multicentric studies are required.

Combined Modality Therapy↗
PubMed1999

The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy.

BACKGROUND: Surgical treatment of breast cancer traditionally has included resection of the nipple-areola complex (NAC), in the belief that this area had a significant probability of containing occult tumors. The purpose of this study was to investigate the true incidence of NAC involvement in patients who underwent a skin-sparing mastectomy (SSM) and to determine associated risk factors. METHODS: A retrospective chart review was conducted of 326 patients who had a SSM at our institution from 1990 to 1993. NAC involvement was reviewed in 286 mastectomy specimens. The charts were analyzed for tumor size, site, histology, grade, nodal status, recurrence, survival, and NAC involvement. RESULTS: Occult tumor involvement in the NAC was found in 5.6% of mastectomy specimens (16 patients). Four patients would have had NAC involvement identified on frozen section if they had been undergoing a skin-sparing mastectomy with preservation of the NAC. There were no significant differences between NAC-positive (NAC+) and NAC-negative (NAC-) patients in median tumor size, nuclear grade, histologic subtype of the primary tumor, or receptor status. There were significant differences in location of the primary tumor (subareolar or multicentric vs. peripheral) and positive axillary lymph node status. NAC involvement was not a marker for increased recurrence or decreased survival. CONCLUSIONS: Occult NAC involvement occurred in only a small percentage of patients undergoing skin-sparing mastectomies. NAC preservation would be appropriate in axillary node-negative patients with small, solitary tumors located on the periphery of the breast.

Breast Neoplasms↗