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Resolution of Nonmass Enhancement Extension to the Nipple at Breast MRI after Neoadjuvant Chemotherapy: Pathologic Response and Feasibility for Nipple-sparing Mastectomy

Authors
 Soong June Bae  ;  Sung Gwe Ahn  ;  Eun Ji Park  ;  Na Lae Eun  ;  Jee Hung Kim  ;  Jung Hwan Ji  ;  Yoonwon Kook  ;  Ji Soo Jang  ;  Seung Ho Baek  ;  Yoon Jin Cha  ;  Joon Jeong 
Citation
 RADIOLOGY, Vol.307(2) : e221777, 2023-04 
Journal Title
RADIOLOGY
ISSN
 0033-8419 
Issue Date
2023-04
MeSH
Breast Neoplasms* / diagnostic imaging ; Breast Neoplasms* / drug therapy ; Breast Neoplasms* / surgery ; Feasibility Studies ; Female ; Humans ; Magnetic Resonance Imaging ; Mammaplasty* / methods ; Mastectomy / methods ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local / pathology ; Nipples / diagnostic imaging ; Nipples / pathology ; Nipples / surgery ; Retrospective Studies
Abstract
Background Nipple-sparing mastectomy (NSM) is usually contraindicated in patients with nonmass enhancement (NME) extension to the nipple at breast MRI. However, little is known about the feasibility of NSM when NME extension to the nipple resolves after neoadjuvant chemotherapy (NAC). Purpose To evaluate whether NSM is an appropriate surgical procedure for patients in whom NME extension to the nipple resolves after NAC. Materials and Methods This retrospective study included 383 women with NME at baseline MRI who underwent NAC followed by mastectomy between January 2007 and March 2022 at a single institution. NME extension to the nipple was assessed using breast MRI before NAC (hereafter, pre-NAC) and after NAC (hereafter, post-NAC). In 326 women who underwent mastectomy with removal of the nipple-areolar complex, the rate of pathologic analysis-confirmed tumor invasion of the nipple compared with NME extension to the nipple at post-NAC breast MRI was evaluated. Tumor involvement of the nipple was also assessed in those with complete pathologic response at posttreatment MRI. Furthermore, the outcomes in 57 women undergoing NSM were investigated, particularly in patients with NME extension to the nipple at initial diagnosis. Results Of the 326 women who underwent mastectomy with removal of the nipple-areolar complex (mean age, 49 years ± 9.4 [SD]), 217 patients (67%) showed NME extension to the nipple on pre-NAC MRI scans. Among the 153 women (70%) in whom the NME extension to the nipple resolved after NAC, the rate of pathologic analysis-confirmed tumor invasion of the nipple was 2.6% (four of 153 women; 95% CI: 0, 6.5). No pathologic analysis-confirmed tumor invasion of the nipple was detected in 31 women with complete response at MRI. Of the 57 women who underwent NSM, 12 (21%) with resolution of NME extension to the nipple after NAC had no relapse during the median follow-up of 31 months (range, 11-80 months). Conclusion Pathologic analysis-confirmed tumor invasion of the nipple was rare in women with resolution of nonmass enhancement extension to the nipple after neoadjuvant chemotherapy (NAC). Therefore, nipple-sparing mastectomy could be feasible in this population, especially in those with complete MRI response to NAC. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Lee in this issue.
Full Text
https://pubs.rsna.org/doi/10.1148/radiol.221777
DOI
10.1148/radiol.221777
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
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
Kook, Yoonwon(국윤원)
Kim, Jee Hung(김지형) ORCID logo https://orcid.org/0000-0002-9044-8540
Bae, Soong June(배숭준) ORCID logo https://orcid.org/0000-0002-0012-9694
Baek, Seung Ho(백승호)
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
Cha, Yoon Jin(차윤진) ORCID logo https://orcid.org/0000-0002-5967-4064
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196303
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