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.

中文翻译：

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乳腺 MRI 非肿块增强在预测乳头肿瘤受累中的诊断准确性：单一机构的前瞻性研究

背景

尽管术前 MRI 对乳头的非肿块增强 (NME) 扩展经常导致乳头-乳晕复合体 (NAC) 的牺牲，但其与病理证实的 NAC 受累的相关性尚不清楚。

目的

评估在乳房 MRI 中使用 NME 扩展至乳晕下区域来预测病理性乳头受累和保留乳头乳房切除术的资格的诊断准确性。

材料和方法

从 2017 年 11 月到 2019 年 11 月，作者前瞻性地招募了在乳房 MRI 上接受了包括切除 NAC 在内的手术的乳头 2 cm 范围内患有乳腺癌和 NME 的参与者。作者在早期对比阶段获得的图像上评估了与活检证实的肿瘤病变同侧且连续的 NME 扩展。通过使用从整个 NAC 延伸到肿瘤的区域的连续垂直切片来评估病理性乳头受累和从乳头到最近癌细胞的距离。主要终点是 NME 的阳性预测值（PPV），计算如下：（乳腺 MRI 中病理性乳头侵犯和 NME 延伸至乳头的数量/乳房 MRI 中 NME 延伸至乳头的数量）×100 .

结果

在 64 名女性（平均年龄，52 岁 ± 9.8 [标准差]）中，49 名（77%）在乳房 MRI 中 NME 延伸至乳头。NME 延伸至乳头的 PPV 为 86%（49 名女性中的 42 名；95% CI：73, 94）。在没有 NME 延伸到乳头的 15 名参与者中，只有 1 名 (7%) 有病理性乳头受累。使用 NME 延伸至乳头的诊断准确性为 88%（64 名女性中的 56 名；95% CI：77、95）。放射距离与病理距离有很好的相关性（Spearman 相关系数 = 0.71，P = .003）。

结论

术前 MRI 对乳头基部的非肿块增强扩展对于识别乳头的肿瘤受累具有很高的阳性预测价值，这是保留乳头的乳房切除术的禁忌症。

© 北美放射学会，2021

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