title: MRI to Predict Nipple Involvement in Breast Cancer Patients.
abstract: OBJECTIVE
  The selection of breast cancer patients as candidates for nipple-sparing mastectomy (NSM) is dependent on the preoperative detection of neoplastic involvement of the nipple-areola complex (NAC). This cross-sectional study was designed to evaluate the accuracy of preoperative breast MRI as a noninvasive method to predict neoplastic involvement of the nipple.
  
  
  METHODS
  We included 165 female breast cancer patients with a surgical plan that included total mastectomy or breast conservation surgery with the removal of the NAC. All patients underwent MRI before surgery on a 1.5-T unit with a 4-channel in vivo dedicated surface breast coil. One radiologist who was blinded to the results of the histologic evaluations of the specimens evaluated the MRI studies.
  
  
  RESULTS
  Of the 170 mastectomy specimens evaluated, 37 (21.8%) had neoplastic involvement of the NAC. The MRI findings of enhancement between the index lesion and the NAC and of nipple retraction were considered statistically significant predictors of nipple involvement in breast cancer patients (p < 0.01 and p = 0.01, respectively). The negative predictive value of the combination of these MRI findings was 83.3%.
  
  
  CONCLUSIONS
  Breast MRI is a safe noninvasive method to preoperatively evaluate breast cancer patients eligible for NSM with a high specificity and a high negative predictive value when enhancement between the index lesion and the nipple and nipple retraction are analyzed.
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: José Roberto Morales
authors.initials: JR
authors.lastname: Piato
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: Roberta Dantas Jales Alves
authors.initials: RD
authors.lastname: de Andrade
authors.affiliation: 2 Department of Radiology, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Luciano Fernandes
authors.initials: LF
authors.lastname: Chala
authors.affiliation: 2 Department of Radiology, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Nestor
authors.initials: N
authors.lastname: de Barros
authors.affiliation: 3 Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Max Senna
authors.initials: MS
authors.lastname: Mano
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: Alnexadre Santos
authors.initials: AS
authors.lastname: Melitto
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Goncalves
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Soares Junior
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: Edmund Chada
authors.initials: EC
authors.lastname: Baracat
authors.affiliation: 1 Department of Gynecology and Obstetrics, Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255, 10 Andar Cerqueira César, Sao Paulo 05403900, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Filassi
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D015413:Mastectomy, Simple; D009558:Nipples / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care
keywords: MRI; breast cancer; nipple involvement prediction