J Breast Cancer.  2014 Dec;17(4):386-392. 10.4048/jbc.2014.17.4.386.

Magnetic Resonance Imaging and Clinicopathological Factors for the Detection of Occult Nipple Involvement in Breast Cancer Patients

• Byon W
• Kim E
• Kwon J
• Park YL
• Park C

• KMID: 2176131
• DOI: http://doi.org/10.4048/jbc.2014.17.4.386

Abstract

PURPOSE
Nipple sparing mastectomy provides good cosmetic results and low local recurrence rates for breast cancer patients. However, there is a potential risk of leaving an occult tumor within the nipple, which could lead to cancer relapse and poor prognosis for the patient. The objective of this study was to investigate the occult nipple involvement rate in mastectomy specimens, and to identify preoperative magnetic resonance imaging (MRI) findings and the clinicopathological characteristics of the primary tumor that may correlate with nipple invasion.
METHODS
Four hundred sixty-six consecutive mastectomy samples with grossly unremarkable nipples were evaluated. Demographic and clinicopathological data were collected. Nipple involvement was evaluated using serial histological sections. The tumor size and tumor-nipple distance were measured using preoperative MRI images.
RESULTS
Thirty-six of the 466 therapeutic mastectomy specimens (7.7%) were found to have occult nipple involvement. In univariate analysis, tumor size, tumor-nipple distance, lymph node status, p53 mutation, and lymphovascular invasion (LVI) were found to influence the likelihood of nipple involvement. Multivariate logistic regression analysis, adjusted by lymph node status, p53 mutation, and LVI, showed that tumor size and tumor-nipple distance were predictive factors indicating nipple involvement. With regard to tumor location, only tumors in the central area of the breast showed a significant association with nipple involvement.
CONCLUSION
In this study, a statistically significant association was found between occult nipple involvement and tumor size, tumor-nipple distance, axillary lymph node status, LVI, and p53 mutation. A cutoff point of 2.2 cm for tumor size and 2 cm for tumor-nipple distance could be used as parameters to predict occult nipple involvement.

Keyword

Breast; Carcinoma; Magnetic resonance imaging; Mastectomy

MeSH Terms

Breast
Breast Neoplasms*
Humans
Logistic Models
Lymph Nodes
Magnetic Resonance Imaging*
Mastectomy
Nipples*
Prognosis
Recurrence

Figure

• 

  Figure 1 Microscopic findings of nipple involvement. (A) The sagittal section of nipple shows involvement of tumor (black arrow) without epidermal involvement (H&E stain, ×2.5). (B) Magnified view shows underlying lactiferous duct with ductal carcinoma in situ and invasive cancer in stroma (H&E stain, ×100).

• 

  Figure 2 Measurement of tumor-nipple distance in MRI imaging. (A) A vertical line is drawn from the center of the nipple to the chest wall and the distance from the base of the nipple-areolar complex to the chest wall is measured (red line). (B) The vertical distance from the upper most point of the lesion to the chest wall (orange line) and the horizontal distance from this vertical line to the lesion is measured (blue line). MRI=magnetic resonance imaging.

• 

  Figure 3 Diagram of calculation method of tumor-nipple distance. Measurement "a" is calculated by subtracting the lesion-chest wall distance from the nipple-areolar complex base-chest wall distance. Measurement "b" is the horizontal distance from the lesion to the vertical line drawn from the center of the nipple to the chest wall. Measurement "c" is acquired by calculating the number of images between the selected images multiplied by the cut width of each MRI image. MRI=magnetic resonance imaging.

• 

  Figure 4 Odds ratio of nipple involvement according to tumor size and tumor-nipple distance.

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