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

Abstract

Background: Nipple-areola sparing mastectomy (NSM) with immediate implant reconstruction is an option for patients with non-locally advanced breast cancer. The prediction of occult tumour involvement of the nipple-areola complex (NAC) may help select candidates to NSM. Patients and methods: We prospectively recorded clinical and pathological data, magnetic resonance imaging (MRI) results and intraoperative pathological assessments of the subareolar (SD) and proximal nipple ducts (ND) of 112 consecutive breast cancer patients scheduled for NSM. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. Results: Thirty-one patients (27.7%) had tumour involvement of the NAC. At univariate analysis, age (p = 0.001), post-menopausal status (0.003), tumour central location (p = 0.03), tumour-NAC distance measured by MRI (p = 0.000) and intraoperative pathologic assessment (SD + ND) (p = 0.000) were significantly correlated with NAC involvement. At multivariate analysis, only MRI tumour-NAC distance (p = 0.008) and menopausal status (p = 0.039) among all preoperative variables retained statistical significance. The sensitivity and specificity of MRI tumour-NAC distance were 32.2% and 88.6% and those of E-mail address: riccardo.ponzone@ircc.it (R. Ponzone).European Journal of Cancer (2015) 51, 1882-1889 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m intraoperative pathologic assessment were 46.7% and 100%, respectively. Sensitivity, specificity and accuracy of the double assessment (MRI plus intraoperative pathology) were 50.0%, 96.2% and 84.1%, respectively. Conclusion: Intraoperative pathologic assessment and tumour-NAC distance measured by MRI are the most important predictors of occult NAC involvement in breast cancer patients. A negative pathological assessment and a tumour-NAC distance P 5 mm allow optimal discrimination between NAC positive and NAC negative cases and may serve as a guide for the optimal planning of oncological and reconstructive surgery.

MRI to Predict Nipple Involvement in Breast Cancer Patients

“…The distance between the tumor and the NAC, however, was not statistically associated with neoplastic involvement of the NAC in our cohort, contradicting the studies in the literature that indicate that the ideal distance between the tumor and the NAC is 2 cm [19,26,27]. We hypothesize that considering distance between the lesion and the NAC as a categoric variable prevented us from reaching a conclusion regarding the ideal distance.…”

Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

“…Previous studies demonstrate that MRI can provide clinically useful information for patients who are candidates for NSM, such as the presence or absence of malignant involvement of the NAC and the distance between the NAC and tumor (4,(26)(27)(28)(29)(30). Our study suggests an additional practical use for pre-operative MRI.…”

“…MRI is often obtained in patients who are candidates for NSM to determine tumor size, the presence or absence of malignant involvement of the NAC, the distance between the NAC and tumor, and the volume of fibroglandular tissue in the NAC (due to concerns that this residual tissue harbors malignancy potential) (4,(26)(27)(28)(29)(30). Our study suggests that pre-operative MRI can also be used to characterize the vascular supply to the breast in order to predict the likelihood of NAC and skin flap ischemia and necrosis.…”

Role of breast magnetic resonance imaging in predicting malignant invasion of the nipple-areolar complex

“…Some studies had focused on using MRI in prediction of NAC invasion [10–12] ; however, the results were quite varied. The sensitivity was reported ranged from 28% to 100%, and specificity ranged from 22% to 100% according to different study groups.…”