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Diagnostic Accuracy of Nonmass Enhancement at Breast MRI in Predicting Tumor Involvement of the Nipple: A Prospective Study in a Single Institution

Authors
 Soong June Bae  ;  Yoon Jin Cha  ;  Na Lae Eun  ;  Jung Hwan Ji  ;  Dooreh Kim  ;  Janghee Lee  ;  Sung Gwe Ahn  ;  Eon Ju Son  ;  Joon Jeong 
Citation
 RADIOLOGY, Vol.301(1) : 47-56, 2021-10 
Journal Title
RADIOLOGY
ISSN
 0033-8419 
Issue Date
2021-10
MeSH
Adult ; Aged ; Breast / diagnostic imaging ; Breast / pathology ; Breast Neoplasms / diagnostic imaging* ; Breast Neoplasms / pathology* ; Female ; Humans ; Magnetic Resonance Imaging / methods* ; Middle Aged ; Neoplasm Invasiveness ; Nipples / diagnostic imaging* ; Nipples / pathology* ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Republic of Korea
Abstract
Background Although nonmass enhancement (NME) extension to the nipple at preoperative MRI frequently leads to sacrifice of the nipple-areolar complex (NAC), its correlation with pathologically confirmed NAC involvement is unclear. Purpose To evaluate the diagnostic accuracy of using NME extension to the subareolar region at breast MRI to predict pathologic nipple involvement and the eligibility for nipple-sparing mastectomy. Materials and Methods From November 2017 to November 2019, the authors prospectively enrolled participants with breast cancer and NME within 2 cm of the nipple at breast MRI who underwent surgery that included removal of the NAC. The authors evaluated NME extensions that were ipsilateral and contiguous with the biopsy-proven tumor lesions on images acquired during the early contrast phases. Pathologic nipple involvement and the distance from the nipple to the nearest cancer cell were evaluated by using serial vertical sectioning of the area extending from the entire NAC to the tumor. The primary end point was the positive predictive value (PPV) of NME, which was calculated as follows: (number with pathologic nipple invasion and NME extension to the nipple at breast MRI/number with NME extension to the nipple at breast MRI) × 100. Results Of 64 women (mean age, 52 years ± 9.8 [standard deviation]), 49 (77%) had NME extension to the nipple at breast MRI. The PPV of NME extension to the nipple was 86% (42 of 49 women; 95% CI: 73, 94). Among the 15 participants without NME extension to the nipple, only one (7%) had pathologic nipple involvement. The diagnostic accuracy of using NME extension to the nipple was 88% (56 of 64 women; 95% CI: 77, 95). The radiologic distance correlated well with the pathologic distance (Spearman correlation coefficient = 0.71, P = .003). Conclusion Nonmass enhancement extension to the nipple base at preoperative MRI has a high positive predictive value for identifying tumor involvement of the nipple, a contraindication to nipple-sparing mastectomy. © RSNA, 2021 Online supplemental material is available for this article.
Full Text
https://pubs.rsna.org/doi/10.1148/radiol.2021204136
DOI
10.1148/radiol.2021204136
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dooreh(김두레)
Bae, Soong June(배숭준) ORCID logo https://orcid.org/0000-0002-0012-9694
Son, Eun Ju(손은주) ORCID logo https://orcid.org/0000-0002-7895-0335
Ahn, Sung Gwe(안성귀) ORCID logo https://orcid.org/0000-0002-8778-9686
Eun, Na Lae(은나래) ORCID logo https://orcid.org/0000-0002-7299-3051
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
Ji, Junghwan(지정환)
Cha, Yoon Jin(차윤진) ORCID logo https://orcid.org/0000-0002-5967-4064
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187757
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