From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health System, 300 Community Dr, Manhasset, NY 11030.
Radiographics. 2022 Mar-Apr;42(2):321-339. doi: 10.1148/rg.210136. Epub 2022 Feb 18.
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. RSNA, 2022.
保留乳头的乳房切除术（NSM）越来越多地应用于接受乳腺癌治疗和预防乳腺癌风险降低的患者。NSM 被认为对选择合适的患者具有肿瘤学安全性，并与改善的美容效果和生活质量相关。近年来，NSM 的适应证不断扩大，目前只有炎症性乳腺癌或累及乳头的恶性肿瘤被认为是绝对禁忌证。靠近乳头乳晕复合体并累及乳头乳晕复合体的肿瘤很常见，乳腺导管癌可扩散至乳头。因此，准确确定影像学检查中的乳头受累情况对于确定适合 NSM 的患者并预防局部复发至关重要。已描述了多种影像学特征作为乳头受累的预测指标，肿瘤到乳头的距离、索引恶性肿瘤与乳头之间的增强以及乳头回缩显示出最高的预测值。这些特征可以在多模态乳房成像中进行评估，特别是在乳房 MRI 中，其对确定恶性肿瘤中的乳头受累具有很高的特异性和阴性预测值。RSNA，2022 年。
