Laura Martincich MD, Presenter: Nothing to Disclose

Riccardo Ponzone MD, Abstract Co-Author: Nothing to Disclose

Veronica Deantoni MD, Abstract Co-Author: Nothing to Disclose

Marta D'Alonzo BS, Abstract Co-Author: Nothing to Disclose

Franziska Kubatzki MD, Abstract Co-Author: Nothing to Disclose

Daniele Regge MD, Abstract Co-Author: Consultant, im3D SpA

For selected cases, nipple-sparing mastectomy may represent the optimal surgical option oncologically and cosmetically. However, the radiological criteria predicting the tumoural involvement of the nipple-areola complex (NAC) are not yet exhaustively defined. The purpose of the study was to assess the role of Dynamic Contrast-Enhanced MRI (DCE-MRI) in the evaluation of NAC in patients with breast cancer undergoing mastectomy.

The series included the 26 patients with biopsy-proven breast cancer undergoing MRI and treated by mastectomy between January 2009 and January 2010 in our Institution. DCE-MRI were performed by 1.5T equipment, 8-channel coil and 3D high-resolution dynamic sequence (parallel imaging technique, axial/sagittal plane, in plane resolution <1mm). The MRI tumour distance from the NAC was measured on axial and sagittal MIP reconstruction by two radiologists blind to pathology; the smallest distance was considered. The subareolar tissue was removed and specimens were separately evaluated by the pathologist. The MRI measurements were then correlated with pathology. DCE-MRI Sensitivity, Specificity, Accuracy, Positive (PPV) and Negative (NPV) Predictive Values were calculated for evidence of carcinoma within 1cm and 2cm to the NAC.

At pathology tumoural NAC involvement was identified in 12 patients. By considering evidence of carcinoma within 1cm to the NAC, DCE-MRI Sensitivity, Specificity, Accuracy, PPV and NPV were 91% (11/12), 85% (12/14), 88% (23/26), 85% (11/13) and 92% (12/13) respectively (p=.0002). By considering evidence of carcinoma within 2cm to the NAC, DCE-MRI Sensitivity, Specificity, Accuracy, PPV and NPV were 91% (11/12), 64% (9/14), 77% (20/26), 68% (11/16) and 90% (9/10) respectively (p=.005); the three additional false positives occured in patients with multicentric cancer.  

Preoperative DCE-MRI reliably predicts the tumoural involvement of NAC. Our results suggest that DCE-MRI evidence of carcinoma within 1cm to NAC may reduce the false positive cases. The study is still ongoing in order to confirm our data in a larger series of patients.

 Algorithms for prediction of NAC tumoural involvement are mainly based on mammography. Diagnostic performance of DCE-MRI may lead to a revision of radiological criteria currently used.

Martincich, L, Ponzone, R, Deantoni, V, D'Alonzo, M, Kubatzki, F, Regge, D, Prediction of Tumoural Involvement of the Nipple-Areola Complex in Patients with Breast Cancer Undergoing Mastectomy: Role of Dynamic Contrast-enhanced MRI.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9005397.html