Prediction of nipple-areolar complex involvement by breast cancer: role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

Mohamed Ali El-Adalany,Ahmed Abd El-Khalek Abd El-Razek,Dina El-Metwally

doi:10.1186/s43055-021-00516-y

Mohamed Ali El-Adalany, Ahmed Abd El-Khalek Abd El-Razek + Show 1 more

Open Access

https://doi.org/10.1186/s43055-021-00516-y

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Abstract

BackgroundSkin-sparing and nipple-sparing mastectomies were considered as alternative techniques for modified radical mastectomy. In patients who are candidates for nipple-sparing mastectomy, preoperative assessment of the nipple-areolar complex (NAC) is essential for adequate surgical planning. Breast MRI is highly sensitive for cancer detection and has an important role in disease staging. The aim of this study was to estimate the role of DCE-MRI in predicting malignant NAC invasion by underlying breast cancer and assess the best predictors on MRI that can suspect malignant NAC invasion.ResultsOut of the 125 patients with breast cancer, 33 patients (26.4%) showed malignant NAC invasion. On basis of multivariate analysis, abnormal nipple enhancement, tumor nipple enhancement, tumor nipple distance ≤ 2 cm, and abnormal and asymmetric nipple morphology were all significant predictors of malignant NAC invasion (P < 0.001) with abnormal unilateral nipple enhancement as the most important independent MRI predictor of malignant NAC invasion (odds ratio = 61.07, 95% CI 12.81–291.22, P < 0.001). When combining more than positive suspicious MRI features, DCE-MRI had 66.6% sensitivity, 76% specificity, 50% PPV, 86.4% NPV, and 73.6% accuracy in prediction of malignant NAC invasion.ConclusionDCE-MRI could predict malignant NAC invasion with abnormal unilateral nipple enhancement as the most important independent MRI predictor.

Highlights

Skin-sparing and nipple-sparing mastectomies were considered as alternative techniques for modified radical mastectomy
Several clinical and pathological factors are suspected to be associated with occult invasion of the nipple-areolar complex (NAC) by the underlying breast cancer such as tumor size, multicentric tumor, central location of the tumor, and proximity of the tumor to the nipple base [7]
After reviewing the pathological reports, we found that 33 cases (26.4%) showed malignant NAC invasion and 92 cases (73.6%) showed free NAC

Summary

Introduction

Skin-sparing and nipple-sparing mastectomies were considered as alternative techniques for modified radical mastectomy. In patients who are candidates for nipple-sparing mastectomy, preoperative assessment of the nipple-areolar complex (NAC) is essential for adequate surgical planning. Skinsparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) were considered as alternative techniques for modified radical mastectomy (MRM) [3]. They provide better cosmetic outcomes resulting in improved body image and more patient satisfaction with more. In patients who are candidates for NSM, preoperative assessment of the nipple-areolar complex (NAC) is essential for adequate surgical planning [6]. Breast MRI is highly sensitive for cancer detection and has an important role in disease staging It is considered the imaging modality of choice for the assessment of malignant invasion of the NAC [8]

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