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.

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Morphological and kinetic characteristics of dynamic contrast-enhanced MRI (DCE-MRI) correlated with histopathological factors of breast cancer: A potential prognostic role of breast MRI?

European Journal of Radiography ◽

10.1016/j.ejradi.2010.02.002 ◽

2009 ◽

Vol 1 (4) ◽

pp. 124-132 ◽

Cited By ~ 3

Author(s):

Katerina Vassiou ◽

Theodora Kanavou ◽

Marianna Vlychou ◽

Antigoni Poultsidi ◽

Maria Ioannou ◽

...

Keyword(s):

Breast Cancer ◽

Breast Mri ◽

Kinetic Characteristics ◽

Prognostic Role ◽

Dce Mri ◽

Dynamic Contrast Enhanced Mri ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced ◽

Contrast Enhanced Mri

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Comparison of terminal duct lobular units in the nipple areolar complex by tumor subtypes-the implication for nipple sparing mastectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12082 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12082-e12082

Author(s):

Kenna Schnarr ◽

Fang Fan ◽

Amanda Leigh Amin ◽

Christa Balanoff ◽

Joshua Mammen ◽

...

Keyword(s):

Breast Cancer ◽

Statistical Significance ◽

Breast Cancer Subtype ◽

Tumor Subtype ◽

Luminal B ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Significant Difference ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

e12082 Background: Nipple-sparing mastectomy (NSM) has gained popularity for surgical treatment of breast cancer. Terminal duct lobular units (TDLU) have been shown to be present in 25% of nipple areolar complex (NAC). Pathologic tumor subtype influence on presence of TDLU in the NAC has not been assessed. In addition, criteria for technically performing the dissection below the NAC have not been established. We sought to evaluate TDLU characteristics by tumor subtype and determine NSM dissection criteria below the NAC. Methods: A retrospective review was performed of 120 total and skin sparing mastectomies, 30 of each breast cancer subtype, from 1/2013 to 1/2015. The NAC of each mastectomy was assessed for number of TDLU and distance from TDLU to the skin. Results: Thirty of the 120 mastectomies (25%) had TDLU present below the NAC. Of the 30 with TDLU, there was no statistically significant difference in number of TDLU present based on tumor grade (gd) (gd 1 vs 2, p = .67; gd 1 vs 3, p = .24). Compared to luminal A, luminal B showed statistical significance (p < .05) for number of TDLU at the NAC whereas Her 2 and triple negative breast cancer (TNBC) were not statistically significant (p = .09 and .10). In mastectomies with TDLU present, gd 2 (p < .05) and gd 3 (p = .05) had a closer skin distance than gd 1. When compared by tumor subtype, there was no difference in TDLU to skin distance (table). Conclusions: NSM has been adopted as a safe oncologic approach to breast cancer treatment. Although presence of TDLU in luminal B subtype was statistically significant, this may not be clinically significant, as there were only 2 of 30 cases with TDLU. Our study indicates that a careful dissection at the level of the dermis below the NAC is necessary, as 25% of women will have TDLU present. This will provide an appropriate oncologic outcome similar to total and skin sparing mastectomy. Tumor subtype does not appear to be exclusion criteria for NSM. However, more aggressive dissection may be necessary to clear all TDLU from below the NAC in higher gd cancers. [Table: see text]

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Clinical value of delayed 18F-FDG PET/CT for predicting nipple-areolar complex involvement in breast cancer: A comparison with clinical symptoms and breast MRI

PLoS ONE ◽

10.1371/journal.pone.0203649 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0203649

Author(s):

Jang Yoo ◽

Bom Sahn Kim ◽

Jin Chung ◽

Hai-Jeon Yoon

Keyword(s):

Breast Cancer ◽

Fdg Pet ◽

Clinical Symptoms ◽

Breast Mri ◽

Clinical Value ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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The Role of Sharp Dissection in Nipple-Sparing Mastectomy: A Safe Procedure with No Necrosis of the Nipple-Areolar Complex

Cancer Management and Research ◽

10.2147/cmar.s230787 ◽

2019 ◽

Vol Volume 11 ◽

pp. 10223-10228

Author(s):

Ci-Qiu Yang ◽

Fei Ji ◽

Hong-Fei Gao ◽

Liu-Lu Zhang ◽

Mei Yang ◽

...

Keyword(s):

Safe Procedure ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Sharp Dissection ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Dynamic contrast-enhanced breast MRI features correlate with invasive breast cancer angiogenesis

npj Breast Cancer ◽

10.1038/s41523-021-00247-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jennifer Xiao ◽

Habib Rahbar ◽

Daniel S. Hippe ◽

Mara H. Rendi ◽

Elizabeth U. Parker ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Characteristic Curve ◽

Breast Mri ◽

Texture Features ◽

Dce Mri ◽

Dynamic Contrast Enhanced ◽

Mri Features ◽

Contrast Enhanced ◽

Initial Peak

AbstractAngiogenesis is a critical component of breast cancer development, and identification of imaging-based angiogenesis assays has prognostic and treatment implications. We evaluated the association of semi-quantitative kinetic and radiomic breast cancer features on dynamic contrast-enhanced (DCE)-MRI with microvessel density (MVD), a marker for angiogenesis. Invasive breast cancer kinetic features (initial peak percent enhancement [PE], signal enhancement ratio [SER], functional tumor volume [FTV], and washout fraction [WF]), radiomics features (108 total features reflecting tumor morphology, signal intensity, and texture), and MVD (by histologic CD31 immunostaining) were measured in 27 patients (1/2016–7/2017). Lesions with high MVD levels demonstrated higher peak SER than lesions with low MVD (mean: 1.94 vs. 1.61, area under the receiver operating characteristic curve [AUC] = 0.79, p = 0.009) and higher WF (mean: 50.6% vs. 22.5%, AUC = 0.87, p = 0.001). Several radiomics texture features were also promising for predicting increased MVD (maximum AUC = 0.84, p = 0.002). Our study suggests DCE-MRI can non-invasively assess breast cancer angiogenesis, which could stratify biology and optimize treatments.

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Oncologic Safety of Skin-Sparing and Nipple-Sparing Mastectomy: A Discussion and Review of the Literature

International Journal of Surgical Oncology ◽

10.1155/2012/921821 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Christopher Tokin ◽

Anna Weiss ◽

Jessica Wang-Rodriguez ◽

Sarah L. Blair

Keyword(s):

Breast Cancer ◽

Breast Conservation ◽

Surgical Techniques ◽

Breast Conservation Therapy ◽

Review Of The Literature ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Skin Envelope ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

Breast conservation therapy has been the cornerstone of the surgical treatment of breast cancer for the last 20 years; however, recently, the use of mastectomy has been increasing. Mastectomy is one of the most frequently performed breast operations, and with novel surgical techniques, preservation of the skin envelope and/or the nipple-areolar complex is commonly performed. The goal of this paper is to review the literature on skin-sparing mastectomy and nipple-sparing mastectomy and to evaluate the oncologic safety of these techniques. In addition, this paper will discuss the oncologic importance of margin status and type of mastectomy as it pertains to risk of local recurrence and relative need for adjuvant therapy.

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Experience and outcomes of nipple-sparing mastectomy following reduction mammoplasty.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.193 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 193-193

Author(s):

Michael Alperovich ◽

Keith M. Blechman ◽

Fares Samra ◽

Richard Shapiro ◽

Deborah M. Axelrod ◽

...

Keyword(s):

Breast Cancer ◽

Medical Center ◽

Cancer Recurrence ◽

Reduction Mammoplasty ◽

Nipple Areolar Complex ◽

Implant Complications ◽

Areolar Complex ◽

History Of ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

193 Background: Breast cancer resection strives for less radical approaches that offer superior aesthetic results without compromising oncologic safety. Nipple-sparing mastectomy (NSM) has gained popularity, but usually has been offered to smaller breasted and minimally ptotic women without history of extensive breast surgery. We present a series of nine nipple-sparing mastectomies following reduction mammoplasty. Methods: Charts of patients who underwent NSM following reduction mammoplasty at the NYU Medical Center from 2006 through 2011 were reviewed. Outcomes measured include post-operative complications, breast cancer recurrence, presence of cancer in the nipple-areolar complex, and nipple-areolar complex viability. Results: In total, the records of 235 (145 prophylactic, 90 therapeutic) NSM patients at NYU Medical Center were reviewed. Six patients for a total of 9 breasts had NSM following reduction mammoplasty. This subset of patients had a mean age of 46.2, mean BMI of 25.1, no history of diabetes and 1 smoker. Seven of 9 breasts were therapeutic resections and 2 of 9 were prophylactic. Time elapsed between reduction mammoplasty and NSM ranged from 33 days to 11 years. The majority of resections were in Stage 0 patients (6/9) with 1/9 in Stage I and 2/9 in Stage IIA. In all cases, prior reduction mammoplasty incisions were utilized for NSM. Eight patients were reconstructed immediately with tissue expanders, and 1 patient had a latissimus dorsi flap with immediate implant. Complications included 1 hematoma requiring evacuation and 1 displaced implant requiring revision. There were no positive subareolar biopsies and 100% nipple viability. Mean follow-up time was 9.4 months. Conclusions: Our experience demonstrates that NSM can be offered following reduction mammoplasty with comparable reconstructive outcomes to NSM alone. Reduction mammoplasty followed by NSM has potential as a reconstructive tool in prophylactic cases unsuited for primary NSM.

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