Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China.
Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China.
Eur Radiol. 2021 Jun;31(6):3683-3692. doi: 10.1007/s00330-020-07550-w. Epub 2020 Nov 27.
To determine the value of a maximum-intensity projection (MIP) image derived from abbreviated breast MRI for excluding occult nipple-areolar complex (NAC) involvement in patients with breast cancer.
This prospective study included breast cancer patients with clinically normal NACs between April 2016 and May 2019. Abbreviated breast MRI was performed, and an MIP image was generated for each patient. MIP images were examined for the following features: asymmetric nipple enhancement, tumor-nipple distance (TND), tumor diameter, lesion type, location, and multifocality. Independent predictive MIP features for occult NAC involvement were identified by univariable and multivariable logistic regression analyses. Models based on independent predictive MIP features were developed, and their diagnostic performances were evaluated using ROC analysis. The utility of an MIP image for excluding occult NAC involvement was assessed by considering NPVs across patient subgroups.
Eight hundred forty-three patients (67 NAC-positive and 776 NAC-negative) were enrolled. On MIP images, asymmetric nipple enhancement (odds ratio, 6.098; p < 0.001) and TND (odds ratio, 0.564; p = 0.003) were independent predictors of occult NAC involvement. A parallel test model of "asymmetric nipple enhancement or TND ≤ 15 mm" yielded the highest AUC value (0.838) among prediction models. The NPV of MIP images for excluding occult NAC involvement was 99.5%, which was applicable across various patient subgroups.
A single MIP image derived from abbreviated breast MRI has utility for excluding occult NAC involvement in breast cancer patients and reducing the number of unnecessary sub-nipple biopsies in nipple-sparing mastectomy.
• On MIP images derived from abbreviated breast MRI, asymmetric nipple enhancement and tumor-nipple distance were independent predictors for occult nipple involvement in patients with breast cancer. • Negative findings on MIP image can help select patients at minimal risk of occult nipple involvement, for whom unnecessary intraoperative sub-nipple biopsies in nipple-sparing mastectomy can be omitted.
确定从简化乳腺 MRI 获得的最大强度投影（MIP）图像在排除乳腺癌患者隐匿性乳头乳晕复合体（NAC）受累方面的价值。
本前瞻性研究纳入了 2016 年 4 月至 2019 年 5 月期间临床 NAC 正常的乳腺癌患者。对所有患者进行简化乳腺 MRI 检查，并为每位患者生成 MIP 图像。评估 MIP 图像的以下特征：不对称性乳头强化、肿瘤乳头距离（TND）、肿瘤直径、病变类型、位置和多灶性。通过单变量和多变量逻辑回归分析确定隐匿性 NAC 受累的独立预测性 MIP 特征。基于独立预测性 MIP 特征开发模型，并通过 ROC 分析评估其诊断性能。通过考虑不同患者亚组的 NPV，评估 MIP 图像排除隐匿性 NAC 受累的效用。
共纳入 843 例患者（67 例 NAC 阳性和 776 例 NAC 阴性）。在 MIP 图像上，不对称性乳头强化（比值比，6.098；p<0.001）和 TND（比值比，0.564；p=0.003）是隐匿性 NAC 受累的独立预测因子。“不对称性乳头强化或 TND≤15mm”的平行检验模型在预测模型中具有最高的 AUC 值（0.838）。MIP 图像排除隐匿性 NAC 受累的 NPV 为 99.5%，适用于各种患者亚组。
从简化乳腺 MRI 获得的单个 MIP 图像可用于排除乳腺癌患者隐匿性 NAC 受累，并减少保乳乳房切除术时不必要的乳头下活检数量。
在简化乳腺 MRI 获得的 MIP 图像上，不对称性乳头强化和肿瘤乳头距离是乳腺癌患者隐匿性乳头受累的独立预测因子。
MIP 图像阴性结果有助于选择隐匿性乳头受累风险最小的患者，对于这些患者，保乳乳房切除术中可省略不必要的乳头下活检。
