INDICATION OF BREAST CONSERVATIVE SURGERY FOR PRIMARY BREAST CANCER USING COMPUTER GRAPHIC THREE-DIMENSIONAL RECONSTRUCTION OF THE MAMMARY DUCT-LOBULAR SYSTEMS

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Intraductal spread of breast cancer can occur along the mammary duct/lobular systems (MDLS) with no invasion of tissues. As ductal anastomoses in the MDLS are considered a possible risk factor for extensive intraductal spread of breast cancer, the architecture of MDLS has important therapeutic implications for patients treated by breast-conserving surgery. An entire breast resected by subcutaneous mastectomy from a 69-year-old woman with ductal carcinoma in situ (DCIS) was examined in subgross sections by stereomicroscopic and histologic techniques. Serial 2-mm sections were subjected to computer-assisted complete three-dimensional reconstruction of all MDLS. The entire breast used contained 16 MDLS, radially arranged with the nipple at the center. Of 16 MDLS, 4 (25.0%) had ductal anastomoses while the remaining 12 MDLS had no ductal anastomoses and completely independent regional anatomy. Ductal anastomoses were observed at 11 sites in the 4 MDLS. The 2 (18.2%) of 11 ductal anastomoses that connected different MDLS were situated more than 4 cm from the nipple. The remaining 9 connected ducts within the same MDLS ; their location varied from near the nipple to the peripheral region. In the case examined, DCIS extended only within a single MDLS, and did not spread between different MDLS via ductal anastomoses. The complete architecture of all MDLS in an entire breast was studied three-dimensionally for the first time to the authors' knowledge. The risk of extending intraductal spread during surgery may be greater where intraductal lesions extend more peripherally than centrally. Individualizing the extent of surgical resection based on the anatomy of MDLS should help to minimize the risk of leaving residual carcinoma at surgical margins.