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

Abstract

Background 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. 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. Results Out 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. Conclusion DCE-MRI could predict malignant NAC invasion with abnormal unilateral nipple enhancement as the most important independent MRI predictor.

A Nomogram to Predict Noninflammatory Skin Involvement of Invasive Breast Cancer

“…M. Yang et al [ 10 ] found that breast cancer patients with larger primary tumor and more regional lymph node metastasis were more likely to have skin invasion. A study found that tumor type, HER-2 status, and PR status were significant predictors of malignant papillary areola complex invasion, and the P values are, respectively, 0.006, <0.001, and 0.014 [ 9 ]. A British study found that more than 4 lymph node metastases in breast cancer patients (HR 8.0, P < 0.001) and involved surgical margins (HR 3.3, P = 0.002) were predictor of local recurrence of breast cancer [ 11 ].…”

“…Thus, whether the skin is involved by tumor or not is extremely important. Generally speaking, breast skin involvement is assessed by physical examination and ultrasound, mammography, or MR. M A EL-Adalany et al analyzed 125 breast cancer patients and found that abnormal unilateral nipple enhancement was the most important independent MRI predictor of malignant NAC invasion ( P < 0.001) [ 9 ]. In this nomogram, we found that age, histological grade, and numbers of lymph node metastases, race, ER status, PR status, Her-2 status, and tumor size were independent predictors of breast cancer skin involvement.…”