ACCURACY OF FROZEN SECTION, IMPRINT CYTOLOGY AND CONVENTIONAL PARAFFIN EXAMS OF SUB-NIPPLE TISSUE DURING INTRAOPERATIVE AND POSTOPERATIVE TIME TO PREDICT NEOPLASTIC NIPPLE INVOLVEMENT IN PATIENTS WITH BREAST CARCINOMA.

Occult nipple involvement for cancer occurs about 10-14%. Sub-nipple tissue (SNT) exam has been used by some surgeons to preserve or not the nipple in nipple sparing mastectomy. Intraoperative exam of SNT becomes an important tool, but it´s uncertain if the SNT evaluation can safely predict the nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, positive and negative predictive values (PPV/NPV) of intraoperative frozen section (FS) and imprint cytology (IC), and postoperative paraffin histopathology of SNT to predict involvement of the nipple in breast carcinoma (BC). It was realized a prospective study with 68 consecutive BC undergone mastectomy, excluding inflammatory carcinoma and clinical evident nipple involvement. After mastectomy, the nipple areolar complex was dissected simulating nipple-sparing flap. The SNT was removed and submitted to FS and IC in intraoperative time and then submitted to routine paraffin histopathology. The nipple was examined separately by paraffin histopathology. We considered any atypical cells like positive. Occult nipple involvement rate was 11.7%; the mean age was 60.8 years; the mean tumor size was 29.7mm in clinical exam and 27,7mm in pathological exam. The mean distances from tumor to nipple were 24.3mm and 33.5mm in clinical and mammographic exams. The FS, IC and paraffin of SNT showed: accuracy 86.8%, 76.5% and 86.8%; sensitivity 50%, 37.5% and 62.5%; specificity 91.7%, 81.7% and 90%; PPV 44.4%, 21.4% and 45.5%; NPV 93.2%, 90.7% and 94.7% respectively. Accuracy of FS was similar to paraffin (p=0.77) and both were better than IC (p=0.01). Our data suggests that SNT evaluation is a good method to predict nipple occult involvement; on the other hand it is not totally safe. The outcomes showed a good accuracy and low false negative rate of intraoperative exam of SNT. When we compared both exams, FS had better accuracy than IC.