Prediction of nipple and areola involvement in breast cancer

Aims To find a pre-operative test for nipple and areola involvement in breast cancer. Methods Areola—tumour distance was measured in 140 consecutive patients (median age 45, range: 23–83) undergoing a mastectomy. We analysed whether nipple and areola correlated with areola—tumour distance, tumour size, nodal status, perinodal involvement and lymphatic embolization. Results The nipple was involved in 22 (16%) cases and this correlated with tumour size, number of lymph nodes, perinodal extension and presence of lymphatic emboli. In all these 22 cases, the tumour was within 2.5 cm of the areola. Tumour size, however, could not predict nipple involvement in tumours within 2.5 cm of the areolar edge. Conclusions In the one-fifth of cases where the tumour is over 2.5 cm from the areola, preserving the nipple and areola for reconstruction may be worthwhile. In remaining cases, some other predictive test for nipple involvement would be necessary.