Malignant Invasion of the Nipple-Areolar Complex of the Breast: Usefulness of Breast MRI

Abstract

MRI is a useful method for the evaluation of malignant invasion of the nipple-areolar complex. Nipple-areolar complex enhancement with thickening could suggest the possibility of nipple involvement.

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

“…The rates of tumour NAC involvement in the literature are inconsistent [14][15][16][17][18][19][20][21] likely due to different pathological protocols for NAC evaluation and variable accuracy of clinical and pathological data collection. For example, a recent systematic review of the literature showed that only 6.4% of the nipple cores of 2477 NAC sparing mastectomies were involved with tumour [13].…”

“…In our previous retrospective study [18], by setting the cut-off of the tumour-NAC distance at 10 mm, MRI outperformed MX in the prediction of NAC involvement with a sensitivity of 100% versus 71% and a specificity of 66% versus 63% respectively. Moon et al [21] in a retrospective analysis of 51 breast cancers reported that NAC enhancement at MRI had a sensitivity of 93.8% and a specificity of 85.7%. In the current prospective study, axial tumour-NAC distance at MRI with a cut-off set at 10 mm had lower sensitivity (53.6% versus 100%), but higher specificity (88.6% versus 66.0%) as compared to our retrospective study [18], and its overall accuracy was slightly increased by setting the cut-off at 5 mm (78.5% versus 75.8%).…”

Can preoperative 3-T MRI predict nipple–areolar complex involvement in patients with breast cancer?

“…Also, breast MRI can describe morphological appearance and enhancement patterns of NAC as well as accurate determination of tumor size and location [13][14][15][16][17]. The sensitivity and specificity of 1.5-T MRI were 56%-93.8% and 85.7%-95%, respectively, in previous studies [1,9]. Comparing 1-T and 1.5-T magnetic resonance (MR) systems, 3-T MRI showed increased signalto-noise ratio (SNR), spatial resolution, and temporal resolution [12].…”

“…NAC involvement was defined as three categories on the basis of previous studies [1,9,20,21]. Firstly, continuity to NAC was defined as linear enhancement direct from primary mass (Fig.…”

“…Although, the utility of preoperative breast MRI is controversial, prediction of NAC involvement is important because it can aid the surgeon to decide the surgical method. Occult NAC involvement is difficult to detect by clinical examination, mammography, or ultrasound alone [9][10][11].…”