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Fang J, Deng Q, Zhang J, Ma Y, Jin C, Lu J, Hao Y, Ma Y, Liu W, Li Z, Liu G, Mo Y, Xiao Y, Zheng C, Yang Y, Wu T, Zhao C, Zhou X, Zhou P. A Nomogram Based on Conventional and Contrast-Enhanced Ultrasound for Pre-operative Prediction of Nipple-Areola Complex Involvement in Breast Cancer: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2565-2572. [PMID: 37752018 DOI: 10.1016/j.ultrasmedbio.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Accurately predicting nipple-areola complex (NAC) involvement in breast cancer is essential for identifying eligible patients for a nipple-sparing mastectomy. This study was aimed at developing a pre-operative nomogram for NAC involvement in breast cancer using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). METHODS All patients with primary breast cancer confirmed by pre-operative biopsy underwent US and CEUS examinations. Post-operative pathology was used as the gold standard in assessing NAC involvement. Lasso regression was used to select the predictors most associated with NAC involvement. A nomogram was constructed to calculate the diagnostic efficacy. The data were internally verified with 500 bootstrapped replications, and a calibration curve was generated to validate the predictive capability. RESULTS Seventy-six patients with primary breast cancer were included in this study, which included 16 patients (21.1%) with NAC involvement and 60 patients (78.9%) without NAC involvement. Among the 23 features of US and CEUS, Lasso regression selected one US feature and two CEUS features, namely, ductal echo extending from the lesion, ductal enhancement extending to the nipple and focal nipple enhancement. A nomogram was constructed, and the results revealed that the area under the curve, sensitivity, specificity and accuracy were 0.891, 81.3%, 86.7% and 85.5%, respectively. The calibration curve exhibited good consistency between the predicted probability and the actual probability. CONCLUSION The nomogram developed based on US and CEUS had good performance in predicting NAC involvement in breast cancer before surgery, which may facilitate the selection of suitable patients for NAC preservation with greater oncological safety.
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Affiliation(s)
- Jinghui Fang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qiongxia Deng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jingwen Zhang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yuqin Ma
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianghao Lu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yanli Hao
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yuanyuan Ma
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weizong Liu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhengyi Li
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Guowen Liu
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yongpan Mo
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yu Xiao
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chang Zheng
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yajie Yang
- Department of Pathology, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Tingting Wu
- Department of Pathology, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chao Zhao
- Bionic Sensing and Intelligence Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xin Zhou
- Bionic Sensing and Intelligence Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Peng Zhou
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China.
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Bae SJ, Ahn SG, Park EJ, Eun NL, Kim JH, Ji JH, Kook Y, Jang JS, Baek SH, Cha YJ, Jeong J. Resolution of Nonmass Enhancement Extension to the Nipple at Breast MRI after Neoadjuvant Chemotherapy: Pathologic Response and Feasibility for Nipple-sparing Mastectomy. Radiology 2023; 307:e221777. [PMID: 36749210 DOI: 10.1148/radiol.221777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Soong June Bae
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Sung Gwe Ahn
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Eun Ji Park
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Na Lae Eun
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Jee Hung Kim
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Jung Hwan Ji
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Yoonwon Kook
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Ji Soo Jang
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Seung Ho Baek
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Yoon Jin Cha
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
| | - Joon Jeong
- From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)
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Lee SC, Mendez-Broomberg K, Eacobacci K, Vincoff NS, Gupta E, McElligott SE. Nipple-sparing Mastectomy: What the Radiologist Should Know. Radiographics 2022; 42:321-339. [PMID: 35179983 DOI: 10.1148/rg.210136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Nipple-sparing mastectomy (NSM) is increasingly offered to patients undergoing treatment of breast cancer and prophylaxis treatment for reduction of breast cancer risk. NSM is considered oncologically safe for appropriately selected patients and is associated with improved cosmetic outcomes and quality of life. Accepted indications for NSM have expanded in recent years, and currently only inflammatory breast cancer or malignancy involving the nipple is considered an absolute contraindication. Neoplasms close to and involving the nipple areolar complex are common, and cancer of the lactiferous ducts can spread to the nipple. Therefore, accurate determination of nipple involvement at imaging examinations is critical to identifying appropriate candidates for NSM and preventing local recurrence. Multiple imaging features have been described as predictors of nipple involvement, with tumor to nipple distance, enhancement between the index malignancy and the nipple, and nipple retraction demonstrating the highest predictive values. These features can be assessed at multimodality breast imaging, particularly at breast MRI, which demonstrates high specificity and negative predictive value for determining nipple involvement in malignancy. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Samantha C Lee
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Karen Mendez-Broomberg
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Katherine Eacobacci
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Nina S Vincoff
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Ekta Gupta
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
| | - Suzanne E McElligott
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030
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Bae SJ, Cha YJ, Eun NL, Ji JH, Kim D, Lee J, Ahn SG, Son EJ, Jeong J. Diagnostic Accuracy of Nonmass Enhancement at Breast MRI in Predicting Tumor Involvement of the Nipple: A Prospective Study in a Single Institution. Radiology 2021; 301:47-56. [PMID: 34254854 DOI: 10.1148/radiol.2021204136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- Soong June Bae
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Yoon Jin Cha
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Na Lae Eun
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Jung Hwan Ji
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Dooreh Kim
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Janghee Lee
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Sung Gwe Ahn
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Eon Ju Son
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
| | - Joon Jeong
- From the Departments of Surgery (S.J.B., J.H.J., D.K., J.L., S.G.A., J.J.), Pathology (Y.J.C.), and Radiology (N.L.E., E.J.S.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
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Coşkun Bilge A, Aydın H, Bostancı IE, Tanişman Ö, Saygılı Öz D. Comparison of the Magnetic Resonance Imaging Findings of Paget's Disease of the Breast and Malignant Tumor Invasion of the Nipple-Areola Complex. Eur J Breast Health 2021; 17:265-273. [PMID: 34263155 DOI: 10.4274/ejbh.galenos.2021.6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022]
Abstract
Objective We aimed to investigate the distinction between Paget's disease of the breast (PDB) and malignant tumor invasion of nipple-areolar complex (MTION) with Magnetic resonance imaging (MRI) findings without the need for skin punch biopsy. Materials and Methods MRI findings of 16 patients with pathologically proven PDB and 11 patients with pathologically proven MTION were reviewed retrospectively. MRI images were assessed for nipple morphological changes; areolar-periareolar skin changes; thickness, classification, and kinetic characteristics of the nipple-areolar complex (NAC) enhancement; morphological pattern, size, and pathological diagnosis of concomitant malignant lesions; kinetic characteristics of the concomitant malignant lesions enhancement; continuity of enhancement between the nipple and closest concomitant malignant lesion; similarity of enhancement kinetics of the NAC and concomitant malignant lesions; and nipple-to-malignant lesion distance in both patient groups. Results Areolar-periareolar skin thickening was statistically different between the patient groups. Enhancement kinetic pattern was classified as persistent in four patients with MTION and plateau in seven patients with PDB. Moreover, NAC enhancement kinetic characteristics were statistically different between the groups. Invasive ductal carcinoma was detected in three patients with PDB and five patients with MTION. A statistically significant difference in malignant lesion pathological types was detected between the patient groups. Conclusion The significant MRI findings in patients with MTION diagnosed as invasive ductal carcinoma were areolar-periareolar skin thickening and asymmetric NAC enhancement with persistent kinetics pattern. In patients diagnosed with ductal carcinoma in situ, a plateau pattern of asymmetric NAC enhancement without any areolar-periareolar skin changes on MRI may indicate PDB.
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Affiliation(s)
- Almila Coşkun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hale Aydın
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Işıl Esen Bostancı
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Özge Tanişman
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Diba Saygılı Öz
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Samreen N, Madsen LB, Chacko C, Heller SL. Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings. Br J Radiol 2021; 94:20201013. [PMID: 33544650 DOI: 10.1259/bjr.20201013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma in-situ and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.
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Affiliation(s)
- Naziya Samreen
- New York University Long Island Division, Long Island, NY, USA
| | | | - Celin Chacko
- New York University Long Island Division, Long Island, NY, USA
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Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
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Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
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MRI diagnostic features for predicting nipple-areolar-complex involvement in breast cancer. Eur J Radiol 2020; 122:108754. [DOI: 10.1016/j.ejrad.2019.108754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/19/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022]
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Lim S, Park G, Choi HJ, Kwon WJ, Kang BS, Bang M. Use of preoperative mammography, ultrasonography, and MRI to predict nipple areolar complex involvement in breast cancer. Br J Radiol 2019; 92:20190074. [PMID: 31317763 DOI: 10.1259/bjr.20190074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify the predictive factors of cancer invading into the nipple. METHODS Patients with breast cancer undergoing mastectomy between May 2009 and March 2019 were reviewed retrospectively. Of these, those with breast cancer within 2 cm of the nipple areolar complex on ultrasonography were included in this study. Clinicopathological data of the primary tumor and imaging findings from mammography, ultrasonography, and MRI were compared between cases with and without nipple involvement by cancer. RESULTS In total, 156 of the 821 patients identified were included in the analysis. Of them, 29 had nipple involvement by cancer. Univariate analysis revealed that the following imaging results were significantly associated with nipple involvement: perineural invasion, lymphovascular invasion, lymph node metastasis; relation type between the tumor and the nipple on ultrasonography; periareolar skin thickening on mammography; and short tumor-nipple distance, continuous enhancement between the nipple and tumor, skin enhancement, and nipple enhancement on MRI. However, on multivariate logistic regression analysis, only invasion type of tumor on ultrasonography and nipple enhancement and short tumor-nipple distance on MRI were significantly correlated with nipple involvement by cancer. CONCLUSION Imaging findings on preoperative mammography, ultrasonography and MRI are effective predictors for nipple involvement by cancer. ADVANCES IN KNOWLEDGE Preoperative mammography, ultrasonography, and MRI help predict nipple involvement by breast cancer.
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Affiliation(s)
- Soyeoun Lim
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Gyeongmin Park
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hye-Jeong Choi
- Department of Pathology, Ulsan University Hosptial, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Woon Jung Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Byeong Seong Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Minseo Bang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Gao Y, Brachtel EF, Hernandez O, Heller SL. An Analysis of Nipple Enhancement at Breast MRI with Radiologic-Pathologic Correlation. Radiographics 2019; 39:10-27. [DOI: 10.1148/rg.2019180039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yiming Gao
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Elena F. Brachtel
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Osvaldo Hernandez
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Samantha L. Heller
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
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11
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Liao CY, Wu YT, Wu WP, Chen CJ, Wu HK, Lin YJ, Chen ST, Chen DR, Lee CW, Chen SL, Kuo SJ, Lai HW. Role of breast magnetic resonance imaging in predicting malignant invasion of the nipple-areolar complex: Potential predictors and reliability between inter-observers. Medicine (Baltimore) 2017; 96:e7170. [PMID: 28700466 PMCID: PMC5515738 DOI: 10.1097/md.0000000000007170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In this study, we assessed the diagnostic accuracy of breast magnetic resonance imaging (MRI) for evaluation of malignant invasion of the nipple-areolar complex (NAC).Patients with primary operable breast cancer who underwent preoperative breast MRI and received surgery during January 2011 to December 2013 were collected. The accuracy and potential factors of MRI in predicting nipple invasion were evaluated by comparing preoperative MRI with postoperative histopathologic findings. The consistency of interobservers' variances across different radiologists was also compared.Totally, 704 patients were enrolled in this study, and 56 (8%) patients have pathologic NAC invasion. Several MRI factors were potential predictors of nipple invasion. Only unilateral nipple enhancement on MRI was the most significant independent predictor of NAC involvement in multivariate analysis. The statistical measures, such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy of breast MRI were 71.4%, 81.6%, 25.2%, 97.1%, and 80.8%, respectively, in one investigator and 78.6%, 88.1%, 36.4%, 97.9%, and 87.4%, respectively, in the other investigator.MR images showed acceptable accuracy and impressive NPV, but low PPV in evaluation of malignant NAC invasion preoperatively. MRI finding of unilateral nipple enhancement was the most significant predictor of NAC involvement.
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Affiliation(s)
- Chiung-Ying Liao
- Departemnt of Radiology, Changhua Christian Hospital, Changhua Department of Surgery, Ministry of Healthy and Welfare Sinying Hospital, Tainan Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua School of Medicine, National Yang Ming University, Taipei Tumor Center Department of Surgical Pathology, Changhua Christian Hospital, Changhua School of Medicine, Chung Shan Medical University, Taichung Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
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Chan SE, Liao CY, Wang TY, Chen ST, Chen DR, Lin YJ, Chen CJ, Wu HK, Chen SL, Kuo SJ, Lee CW, Lai HW. The diagnostic utility of preoperative breast magnetic resonance imaging (MRI) and/or intraoperative sub-nipple biopsy in nipple-sparing mastectomy. Eur J Surg Oncol 2017; 43:76-84. [DOI: 10.1016/j.ejso.2016.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/17/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022] Open
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13
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Barco I, Chabrera C, García-Fernández A, Fraile M, Vidal MC, González S, Lain JM, Reñé A, Canales L, Vallejo E, Deu J, Pessarrodona A, Giménez N, García-Font M. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease. Eur J Radiol 2016; 85:1786-1793. [DOI: 10.1016/j.ejrad.2016.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 01/22/2023]
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15
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16
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Sisco M, Yao KA. Nipple-sparing mastectomy: A contemporary perspective. J Surg Oncol 2016; 113:883-90. [PMID: 26931641 DOI: 10.1002/jso.24209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/10/2016] [Indexed: 01/17/2023]
Abstract
Increasing numbers of women are undergoing nipple-sparing mastectomy, and evidence to support its use for cancer treatment and prophylaxis is expanding. An understanding of technical aspects and pitfalls of the procedure is paramount to ensure that the best results are attained. J. Surg. Oncol. 2016;113:883-890. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mark Sisco
- Division of Plastic Surgery, Department of Surgery, NorthShore University HealthSystem, Northbrook, Illinois
| | - Katharine A Yao
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Northbrook, Illinois
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Huang NS, Wu J. Nipple-sparing Mastectomy in Breast Cancer: From an Oncologic Safety Perspective. Chin Med J (Engl) 2016; 128:2256-61. [PMID: 26265622 PMCID: PMC4717986 DOI: 10.4103/0366-6999.162500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the oncologic safety of nipple-sparing mastectomy (NSM) for breast cancer patients based on current literature. Data Sources: A comprehensive literature search of Medline, Embase databases was conducted for studies published through March 2014. Study Selection: Our search criteria included English-language studies that focused on NSM at nipple-areola complex (NAC) involvement, patient selection, and recurrence. Prophylaxis NSM, case series or reports that based on very small population were excluded. In the end, 42 studies concerning NSM and oncological safety were included into the review. Results: NSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy. However, the oncologic safety and patient selection criteria associated with NSM are still under debate. The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%, which can be decreased through careful patient selection. Tumour-nipple distance, tumour size, lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations, imaging studies and biopsies to predict the risk of NAC involvement. Currently, there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens. The local recurrence (ranges from 0% to 24%) of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up. The role of radiotherapy in NSM is still controversial and is not universally accepted. Conclusions: NSM appears to be oncologically safe following careful patient selection and assessment of margins.
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Affiliation(s)
| | - Jiong Wu
- Department of Breast Surgery, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Can preoperative 3-T MRI predict nipple–areolar complex involvement in patients with breast cancer? Clin Imaging 2016; 40:119-24. [DOI: 10.1016/j.clinimag.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/20/2015] [Accepted: 08/04/2015] [Indexed: 11/19/2022]
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Breast Cancer Molecular Subtype as a Predictor of the Utility of Preoperative MRI. AJR Am J Roentgenol 2015; 204:1354-60. [DOI: 10.2214/ajr.14.13666] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Local recurrence following treatment for breast cancer with an endoscopic nipple-sparing mastectomy. Breast Cancer 2015; 23:552-60. [DOI: 10.1007/s12282-015-0600-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
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Gomez C, Shah C, McCloskey S, Foster N, Vicini F. The Role of Radiation Therapy after Nipple-Sparing Mastectomy. Ann Surg Oncol 2014; 21:2237-44. [DOI: 10.1245/s10434-013-3446-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Indexed: 11/18/2022]
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22
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Fancellu A, Soro D, Castiglia P, Marras V, Melis M, Cottu P, Cherchi A, Spanu A, Mulas S, Pusceddu C, Simbula L, Meloni GB. Usefulness of magnetic resonance in patients with invasive cancer eligible for breast conservation: a comparative study. Clin Breast Cancer 2013; 14:114-21. [PMID: 24321101 DOI: 10.1016/j.clbc.2013.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/02/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of magnetic resonance imaging (MRI) in newly detected breast cancer remains controversial. We investigated the impact of preoperative MRI on surgical management of infiltrating breast carcinoma (IBC). METHODS We reviewed data of 237 patients with IBC who were suitable for breast-conserving surgery (BCS) between 2009 and 2011. Of these patients, 109 underwent preoperative MRI (46%; MRI group) and 128 did not (54%; no-MRI group). We analyzed MRI-triggered changes in surgical plan and compared differences in rates of positive margins and mastectomy. RESULTS Tumor size was larger in the MRI group (16.8 mm vs. 13.9 mm; P < .001). MRI changed the initial surgical planning in 18 of 109 patients (16.5%) because of detection of larger tumor diameter requiring wider resection (8 patients [7.3%]) or additional malignant lesions in the ipsilateral (9 patients [8.2%]) or contralateral breast (1 patient [0.9%]). MRI-triggered treatment changes included mastectomy (n = 12), wider excision (n = 5), and contralateral BCS (n = 1). Reoperation rates for positive margins after BCS appeared higher in the no-MRI group (4.1% vs. 8.6%), but the difference missed statistical significance (P = .9). Overall mastectomy rates were higher in the MRI group (13.7% vs. 7.0%; P < .05). The likelihood of having a change of treatment resulting from MRI was significantly higher for patients with tumors > 15 mm and for those with positive lymph nodes. CONCLUSION Lymph node positivity and tumor size > 15 mm may predict an MRI-triggered change in surgical plan. Preoperative MRI resulted in higher mastectomy rates justified by biopsy-proven additional foci of carcinoma and did not significantly reduce reoperation rates for positive margins.
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Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy.
| | - Daniela Soro
- Department of Radiology, University of Sassari, Sassari, Italy
| | - Paolo Castiglia
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Pathology, University of Sassari, Sassari, Italy
| | - Marcovalerio Melis
- New York University School of Medicine and Department of Surgery, NY Harbor Healthcare System VAMC, New York, NY
| | - Pietrina Cottu
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Alessandra Cherchi
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Department of Nuclear Medicine, University of Sassari, Sassari, Italy
| | - Silvia Mulas
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Claudio Pusceddu
- Department of Radio-oncology, Oncological Hospital of Cagliari, Cagliari, Italy
| | - Luca Simbula
- Department of Radiology, University of Sassari, Sassari, Italy
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Costantini M, Belli P, Distefano D, Bufi E, Matteo MD, Rinaldi P, Giuliani M, Petrone G, Magno S, Bonomo L. Magnetic resonance imaging features in triple-negative breast cancer: comparison with luminal and HER2-overexpressing tumors. Clin Breast Cancer 2013; 12:331-9. [PMID: 23040001 DOI: 10.1016/j.clbc.2012.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 06/06/2012] [Accepted: 07/09/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND It has been ascertained that triple-negative (TN) breast cancer is characterized by an aggressive clinical course and a poor prognosis. The purpose of our study was to compare the magnetic resonance imaging (MRI) features of the 3 major different breast cancer subtypes (TN, luminal, and human epidermal growth factor receptor 2 [HER2]-overexpressing) and to suggest the criteria that might predict TN phenotype. MATERIALS AND METHODS From October 2007 to April 2011, we studied 77 patients with histologically confirmed TN breast cancer who underwent breast MRI. We randomly included 148 patients with non-TN breast cancer (110 luminal and 38 HER-overexpressing) as a control group. We evaluated the clinicopathologic data, the MRI morphologic and kinetic features, the signal intensity on T2-weighted images, and the apparent diffusion coefficient (ADC). RESULTS Our results confirmed that TN tumors are more aggressive, are usually diagnosed at a younger age compared with the other study groups, and show benign morphologic features with MRI. Backward stepwise logistic regression identified some parameters as independent predictors of TN-type lesions: age, size, shape, presence of edema, and infiltrative characteristics. The receiver operating characteristic (ROC) curve, built with 4 of 5 these factors as criteria to predict TN status, showed a 0.664 area under the curve (AUC) value (sensitivity 58.4%, specificity 73.2%). The inclusion of the fifth criterion showed a 0.699 AUC value (sensitivity, 49.4%; specificity, 89.4%). CONCLUSION We identified the clinicoradiologic parameters that are independent predictors of TN breast lesions, which might be helpful for earlier prediction of the TN status of a breast lesion.
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Affiliation(s)
- Melania Costantini
- Department of Radiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
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