Malignant invasion of the nipple-areolar complex of the breast: usefulness of breast MRI.

Abstract

The objective of our study is to assess the usefulness of breast MRI for the evaluation of malignant invasion of the nipple-areolar complex. Breast MRI findings of 51 pathologically proven breast cancer lesions, which were within 2 cm distance from the nipple-areolar complex on sonography, were reviewed retrospectively. Breast MRI examinations were retrospectively reviewed for nipple inversion or retraction, periareolar skin thickening, nipple-areolar complex enhancement, relationship to the subareolar mass, malignant mass pattern, thickness of nipple-areolar complex enhancement, tumor-nipple distance, and tumor size and were correlated with the pathologic findings. The characteristic findings of Paget disease were reviewed. Mammography was reviewed independently without the knowledge of MRI findings. A statistically significant correlation was found between nipple-areolar complex enhancement and malignant invasion of the nipple-areolar complex, with a sensitivity of 93.8% and a specificity of 85.7%. On the basis of univariate and multivariate analyses, nipple-areolar complex enhancement and thickness of the nipple-areolar complex enhancement correlated significantly with pathologic invasion of the nipple-areolar complex (p < 0.001). Paget disease was confirmed in 63% of the lesions, and all cases of Paget disease revealed nipple-areolar complex enhancement on MRI. No statistically significant correlations were observed between the mammographic findings and malignant invasion of the nipple-areolar complex (p > 0.05). MRI is a useful method for the evaluation of malignant invasion of the nipple-areolar complex. Nipple-areolar complex enhancement with thickening could suggest the possibility of nipple involvement.