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

Abstract

In this study, we assessed the diagnostic accuracy of breast magnetic resonance imaging (MRI) for evaluation of malignant invasion of the nipple-areolar complex (NAC).Patients with primary operable breast cancer who underwent preoperative breast MRI and received surgery during January 2011 to December 2013 were collected. The accuracy and potential factors of MRI in predicting nipple invasion were evaluated by comparing preoperative MRI with postoperative histopathologic findings. The consistency of interobservers’ variances across different radiologists was also compared.Totally, 704 patients were enrolled in this study, and 56 (8%) patients have pathologic NAC invasion. Several MRI factors were potential predictors of nipple invasion. Only unilateral nipple enhancement on MRI was the most significant independent predictor of NAC involvement in multivariate analysis. The statistical measures, such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy of breast MRI were 71.4%, 81.6%, 25.2%, 97.1%, and 80.8%, respectively, in one investigator and 78.6%, 88.1%, 36.4%, 97.9%, and 87.4%, respectively, in the other investigator.MR images showed acceptable accuracy and impressive NPV, but low PPV in evaluation of malignant NAC invasion preoperatively. MRI finding of unilateral nipple enhancement was the most significant predictor of NAC involvement.

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

“…In the present study, abnormal unilateral nipple enhancement was the most important independent MRI predictor of malignant NAC invasion (odds ratio = 61.07, 95% CI 12.81-291.22, P < 0.001) (specificity = 97.8% and diagnostic accuracy = 87.2%). This in agreement with Liao et al [7] who stated that abnormal unilateral nipple enhancement was the most significant independent image predictor of malignant NAC invasion (odds ratio = 4.86, 95% CI 1.76-13.80, P ≤ .01). Also, our results are in agreement with a study performed by Lee et al [17], and they found that MR images displaying inhomogeneous and diffuse enhancement in areas of thickened skin and the parenchyma of the NAC were indicative of NAC invasion.…”

“…The incidence of malignant NAC invasion by underlying breast cancer varies in different studies from 5.6 to 24.6% [14][15][16]. One study showed that malignant invasion of the NAC by underlying breast [1,3,[7][8][9][10][11][12][13][14][15][16]. It was stated that both tumor nipple distance and abnormal enhancement extending from the tumor to the nipple base were the most important predictors of malignant NAC invasion on MRI [9,10].…”

“…In patients who are candidates for NSM, preoperative assessment of the nipple-areolar complex (NAC) is essential for adequate surgical planning [6]. Several clinical and pathological factors are suspected to be associated with occult invasion of the 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]. Mammography and breast ultrasound can be used to predict the malignant invasion of the NAC by underlying breast cancer; however, they have limited sensitivity and specificity.…”

“…Several previous studies investigated the role of breast MRI in the prediction of malignant invasion of the NAC [6][7][8][9][10][11][12][13]. However, there is still debate on what is the most important MRI predictor of malignant NAC invasion by underlying breast cancer.…”

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

“…In the article, “Role of breast magnetic resonance imaging in predicting malignant invasion of the nipple-areolar complex: Potential predictors and reliability between inter-observers”, [ 1 ] which appeared in Volume 96, Issue 28 of Medicine , Dr. Chiung-Ying Liao's named appeared incorrectly as Chun-Ying Liao.…”