Piato José Roberto Morales, de Andrade Roberta Dantas Jales Alves, Chala Luciano Fernandes, de Barros Nestor, Mano Max Senna, Melitto Alnexadre Santos, Goncalves Rodrigo, Soares Junior José Maria, Baracat Edmund Chada, Filassi José Roberto
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.
2 Department of Radiology, Universidade de São Paulo, São Paulo, Brazil.
AJR Am J Roentgenol. 2016 May;206(5):1124-30. doi: 10.2214/AJR.15.15187. Epub 2016 Mar 24.
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.
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.
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%.
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.
选择保留乳头的乳房切除术（NSM）的乳腺癌患者取决于术前对乳头乳晕复合体（NAC）肿瘤累及情况的检测。本横断面研究旨在评估术前乳腺MRI作为预测乳头肿瘤累及情况的非侵入性方法的准确性。
我们纳入了165例计划行全乳切除术或保留乳房手术并切除NAC的女性乳腺癌患者。所有患者在手术前行1.5-T设备、4通道专用乳腺体表线圈的MRI检查。一名对标本组织学评估结果不知情的放射科医生对MRI检查结果进行评估。
在评估的170例乳房切除标本中，37例（21.8%）有NAC肿瘤累及。索引病灶与NAC之间的强化及乳头回缩的MRI表现被认为是乳腺癌患者乳头受累的统计学显著预测因素（分别为p<0.01和p = 0.01）。这些MRI表现联合的阴性预测值为83.3%。
当分析索引病灶与乳头之间的强化及乳头回缩情况时，乳腺MRI是一种安全的非侵入性方法，可用于术前评估适合NSM的乳腺癌患者，具有高特异性和高阴性预测值。
