Preoperative MRI evaluation of lesion–nipple distance in breast cancer patients: thresholds for predicting occult nipple–areola complex involvement

Mariscotti, Giovanna; Durando, Manuela; Houssami, Nehmat; Berzovini, Claudio; Esposito, Francesco; Fasciano, Mirella; Campanino, Pier Paolo; Bosco, Davide; Bussone, Riccardo; Ala, Ada; Castellano, Isabella; Sapino, Anna; Bergamasco, Laura; Fonio, Paolo; Gandini, Giovanni

doi:10.1016/j.crad.2018.03.008

Cited by 22 publications

(9 citation statements)

References 35 publications

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“…The association between tumour-nipple distance and involvement of the nipple-areolar complex (NAC) has been extensively explored, and a smaller tumour-nipple distance was reportedly associated with a higher risk of NAC involvement. [17][18][19][20] Furthermore, in one study, the incidence of axillary lymph node metastasis was significantly higher in patients with nipple involvement (36.71%) than in patients with unifocal tumours (9.76%). 21 Such correlations might explain the association between tumour-nipple distance and axillary status.…”

Section: Discussionmentioning

confidence: 95%

Distance Between the Tumour and Nipple as a Predictor of Axillary Lymph Node Involvement in Breast Cancer

Yang¹,

Yang²,

Mukherjee³

et al. 2021

CMAR

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Section: Discussionmentioning

confidence: 95%

Distance Between the Tumour and Nipple as a Predictor of Axillary Lymph Node Involvement in Breast Cancer

Yang¹,

Yang²,

Mukherjee³

et al. 2021

CMAR

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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]. One stated that TND with cutoff value of 10 mm had high sensitivity and specificity in predicting malignant NAC [3]. Another study stated that Continuity to NAC and unilateral NAC enhancement were all important MRI predictors of malignant NAC invasion [12].…”

Section: Discussionmentioning

confidence: 99%

“…Great efforts were performed in order to introduce more conservative surgeries for the treatment of breast cancer [2]. Skinsparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) were considered as alternative techniques for modified radical mastectomy (MRM) [3]. They provide better cosmetic outcomes resulting in improved body image and more patient satisfaction with more cosmetic results obtained by NSM due to preservation of the NAC [4].…”

Section: Introductionmentioning

confidence: 99%

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

EL-Adalany

El-Razek

EL-Metwally

2021

Egypt J Radiol Nucl Med

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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.

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“…Separately, in a study of 112 patients, Ponzone et al [25] suggested that a TND of 5 mm on MRI is sufficient for NSM eligibility. Other studies pointed out the sensitivity of MRI in detecting NAC involvement; Mariscotti et al [26] conducted a study using MRI and suggested a TND cutoff value of 10 mm.…”

Section: Discussionmentioning

confidence: 99%

Oncologic Outcomes of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Patients with Tumor-Nipple Distance Less than 2.0 cm

et al. 2019

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PurposeAlthough the indications for nipple-sparing mastectomy (NSM) are expanding, there remains a debate regarding the oncologic outcomes of patients treated with this method, especially those with a short tumor–nipple distance (STND). The aim of this study was to compare the long-term oncologic outcomes between patients with a long tumor–nipple distance (LTND) (≥ 2.0 cm) and those with STND (< 2.0 cm).MethodsThis was a retrospective study in which 266 patients who underwent NSM with immediate breast reconstruction between January 2008 and December 2014 at a single institution were enrolled. Of these patients, 21 were excluded because of loss to follow-up; thus, 245 patients were finally analyzed. All patients underwent preoperative breast magnetic resonance imaging and intraoperative frozen biopsy.ResultsThe mean age of the patients was 42.4 years. STND was identified in 128 patients, and LTND in 117 patients. The mean follow-up period was 60.5 months. There were no significant differences between the 2 groups with respect to lymphovascular invasion, nuclear grade, nodal status, and subtype (p = 0.339, 0.372, 0.955, and 0.338, respectively). The STND group had significantly smaller tumors than the LTND group (p = 0.005). The median TND in the STND and LTND groups was 0.7 cm and 3.0 cm, respectively. Locoregional recurrence was reported in 4 patients in the STND group (3.1%) and 6 (5.1%) in the LTND group. A total of 3 patients died (1.2%; 2 in the STND group and one in the LTND group). There was no significant difference between the 2 groups with respect to disease-free survival or local recurrence-free survival (p = 0.334 and p = 0.477, respectively).ConclusionThe long-term oncologic outcomes of patients treated with NSM did not significantly differ according to TND when the intraoperative frozen biopsy was negative for tumor cells.

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Preoperative MRI evaluation of lesion–nipple distance in breast cancer patients: thresholds for predicting occult nipple–areola complex involvement

Cited by 22 publications

References 35 publications

Distance Between the Tumour and Nipple as a Predictor of Axillary Lymph Node Involvement in Breast Cancer

Distance Between the Tumour and Nipple as a Predictor of Axillary Lymph Node Involvement in Breast Cancer

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

Oncologic Outcomes of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Patients with Tumor-Nipple Distance Less than 2.0 cm

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