Huang Jie, He Ni, Li Jiao, Chen Jieting, Guan Canyu, Wu Yaopan, Lu Qianyi
Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China.
Eur Radiol. 2025 Jul 1. doi: 10.1007/s00330-025-11787-8.
To evaluate the diagnostic performance of preoperative contrast-enhanced cone-beam breast CT (CE-CBBCT) and identify significant predictors of nipple-areolar complex (NAC) involvement in early-stage breast cancer patients.
This retrospective study included 641 breast cancer cases from 631 patients at Sun Yat-sen University Cancer Center (2019.3-2021.3). From these, 182 cases were selected after one-by-one matching with the NAC involvement group using the propensity score matching method. Two radiologists independently assessed CE-CBBCT imaging factors in 182 cases. Diagnostic performance indices were analyzed, and predictors of NAC involvement in breast cancer were identified using logistic regression analyses.
The 182 matched cases were females with a median age of 50 (interquartile range, 44-55; range, 25-81 years). Interobserver agreement regarding CBBCT prediction by two radiologists was relatively substantial (κ = 0.730). The accuracy of radiologists in predicting NAC involvement in CE-CBBCT was 83.52% (152/182), with a sensitivity of 96.70% (88/91), specificity of 70.33% (64/91), negative predictive value of 95.52% (64/67), and positive predictive value (PPV) of 76.52% (88/115). On CE-CBBCT, asymmetric NAC enhancement (odds ratio, 5.279; p = 0.001) and TNE (tumor-nipple enhancement) within 2 cm of the NAC (odds ratio, 4.184; p = 0.02) were significant predictors of NAC involvement. When asymmetric NAC enhancement and TNE extending to the NAC were present, the PPV was 82.35% (56/68).
CE-CBBCT is a safe and non-invasive modality with comparably high accuracy for the preoperative diagnosis of NAC involvement. Asymmetric NAC enhancement and TNE within 2 cm of the NAC performed well in predicting NAC involvement.
Question Several imaging modalities have been studied to preoperatively evaluate NAC involvement, but CE-CBBCT's performance was unknown. Findings CE-CBBCT showed high accuracy in diagnosing NAC involvement. Asymmetric NAC enhancement and tumor-nipple enhancement within 2 cm of the NAC were independent predictors of NAC involvement. Clinical relevance CE-CBBCT can serve as a safe, non-invasive modality to diagnose NAC involvement preoperatively and help to identify candidates for nipple-sparing mastectomy.
评估术前对比增强锥形束乳腺CT（CE-CBBCT）的诊断性能，并确定早期乳腺癌患者乳头乳晕复合体（NAC）受累的重要预测因素。
这项回顾性研究纳入了中山大学肿瘤防治中心631例患者的641例乳腺癌病例（2019年3月至2021年3月）。其中，采用倾向评分匹配法与NAC受累组逐一匹配后，选取了182例病例。两名放射科医生独立评估182例病例的CE-CBBCT影像因素。分析诊断性能指标，并使用逻辑回归分析确定乳腺癌NAC受累的预测因素。
182例匹配病例均为女性，中位年龄50岁（四分位间距，44-55岁；范围，25-81岁）。两名放射科医生对CBBCT预测的观察者间一致性较高（κ = 0.730）。放射科医生在CE-CBBCT中预测NAC受累的准确率为83.52%（152/182），敏感性为96.70%（88/91），特异性为70.33%（64/91），阴性预测值为95.52%（64/67），阳性预测值（PPV）为76.52%（88/115）。在CE-CBBCT上，NAC不对称强化（比值比，5.279；p = 0.001）和NAC 2 cm范围内的肿瘤-乳头强化（TNE）（比值比，4.184；p = 0.02）是NAC受累的重要预测因素。当存在NAC不对称强化和延伸至NAC的TNE时，PPV为82.35%（56/68）。
CE-CBBCT是一种安全、无创的检查方法，对术前诊断NAC受累具有较高的准确性。NAC不对称强化和NAC 2 cm范围内的TNE在预测NAC受累方面表现良好。
问题 已对多种影像学检查方法进行研究以术前评估NAC受累情况，但CE-CBBCT的性能尚不清楚。发现 CE-CBBCT在诊断NAC受累方面显示出较高的准确性。NAC不对称强化和NAC 2 cm范围内的肿瘤-乳头强化是NAC受累的独立预测因素。临床意义 CE-CBBCT可作为一种安全、无创的检查方法用于术前诊断NAC受累，并有助于确定保乳手术的候选者。
