title: Predicting nipple-areolar involvement using preoperative breast MRI and primary tumor characteristics.
abstract: BACKGROUND
  Preoperative assessment of the nipple-areolar complex (NAC) is invaluable when considering nipple-sparing mastectomy. Our hypothesis is that breast magnetic resonance imaging (MRI) may predict involvement of the NAC with tumor.
  
  
  METHODS
  Clinical, histopathologic, and imaging data were compiled for patients who underwent preoperative breast MRI followed by mastectomy or nipple-sparing mastectomy for malignancy between 2006 and 2009. Blinded rereview of all MRI studies was performed by a breast MRI imager and compared to initial MRI findings. Multivariate analysis identified variables predicting NAC involvement with tumor.
  
  
  RESULTS
  Of 77 breasts, 18 (23 %) had tumor involving or within 1 cm of the NAC. The sensitivity of detecting histopathologically confirmed NAC involvement was 61 % with history and/or physical examination, and 56 % with MRI. Univariate analysis identified the following variables as significant for NAC involvement: large tumors near the nipple on preoperative MRI, node-positive disease, invasive lobular carcinoma, advanced histopathologic T stage, and neoadjuvant chemotherapy. On multivariate analysis, only tumor size >2 cm and distance from tumor edge to the NAC <2 cm on MRI maintained significance. Pearson correlation coefficient for MRI size compared to histopathologic size was 0.53 (P < 0.0001).
  
  
  CONCLUSIONS
  MRI is not superior to thorough clinical evaluation for predicting tumor in or near the NAC. However, MRI-measured tumor size and distance from the NAC are correlated with increased risk of NAC involvement. The combination of preoperative history and physical examination, tumor characteristics, and breast MRI can aid the surgeon in predicting a tumor-involved nipple more than any single modality alone.
authors.affiliation: Gonda (Goldschmied) Research Laboratories of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA. shwnstn@gmail.com
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Steen
authors.forename: Alice P
authors.initials: AP
authors.lastname: Chung
authors.forename: Soo-Hwa
authors.initials: SH
authors.lastname: Han
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Vinstein
authors.forename: Jeong L
authors.initials: JL
authors.lastname: Yoon
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies