Significance of Non-Mass Enhancement in the Subareolar Region on Preoperative Breast Magnetic Resonance Imaging for Nipple-Sparing Mastectomy

Abstract

The eligibility for NSM regarding to subareolar NME on breast MRI was not clear. The rate of pathologic nipple invasion was as low as 6.1% when NME did not extend to the nipple on breast MRI. NSM is possible if NME does not involve the nipple on breast MRI. Purpose: The eligibility for nipple-sparing mastectomy (NSM) regarding subareolar non-mass enhancement (NME) on breast magnetic resonance imaging (MRI) was not clear. This study aimed to evaluate the eligibility for NSM according to the NME-to-nipple distance on preoperative breast MRI. Methods: We identified patients with breast cancer who underwent mastectomy with NME suspected of malignancy in the subareolar region on preoperative breast MRI. The incidence of nipple invasion was pathologically evaluated according to the NME-to-nipple distance on breast MRI, and the clinicopathologic factors related to pathologic nipple invasion were analyzed. Results: Of 137 patients, 55 (40.1%) had NME extension to the nipple, 53 (38.7%) had radiologic distance less than 2 cm, and 29 (21.2%) had radiologic distance of 2 cm or more. The rate of pathologic nipple invasion was 52.7% (29 of 55) in patients with NME extension to nipple, 7.5% (4 of 53) in patients with NME-to-nipple distance less than 2 cm, and 3.4% (1 of 29) in patients with NME-to-nipple distance of 2 cm or more (P < .001). NME extension to the nipple was an independent risk factor for pathologic nipple invasion (odds ratio 21.702; 95% confidence interval, 2.613e180.225; P ¼ .004). The survival outcome was not different between NSM and conventional total mastectomy/skin-sparing mastectomy in patients with radiologic distance less than 2 cm, but without NME extension to the nipple. Conclusions: NSM is an acceptable procedure in patients with breast cancer with a low incidence of pathologic nipple invasion when there is no evidence of NME extension to the nipple on preoperative breast MRI.

Non-mass Lesions on Preoperative MRI in Breast Cancer: Clinical Implications and Prognostic Significance

“…In the past, research predominantly aimed at separating benign from malignant non-mass lesions (NMLs) to increase the speci city of MRI (3,(8)(9)(10)(11)(12)(13). Recent studies have focused on the pathological characterization of NMLs after core needle biopsies (CNBs), measuring the incidence of cancer in these results (3,14).…”

“…However, knowing the clinical implications of NMLs extends beyond mere detection and classi cation. Prognostic information inferred from NMLs can guide treatment decisions and patient counseling, ensuring a more tailored approach to breast cancer management (8,10,15). This study aims to delve into the clinical implications of NML on preoperative MRI in breast cancer, with a particular emphasis on their signi cance as prognostic indicators, thereby enhancing the utilization of existing information and supporting improved patient treatment.…”

Adenectomia mamária para o tratamento do câncer de mama inicial: importância da avaliação da margem retroareolar e da remoção dos ductos intrapapilares

“…Nesse tipo de ressonância, as sequências T1 e T2 permitem mensurar a distância entre o tumor e a papila, tornando possível a avaliação da presença de realce suspeito com extensão ao CAP. 38 Karamchandani et al 39 A falta de padronização entre os cirurgiões, da técnica da AMT e da avaliação intraoperatória da margem retroareolar, pode levar à remoção do CAP sem o mesmo estar, verdadeiramente, acometido por doença. 22,45 A AIMR apresenta taxa de resultados falso-negativos de 1,5% a 16,2%.…”