Malignant Invasion of the Nipple-Areolar Complex of the Breast: Usefulness of Breast MRI

Abstract

OBJECTIVE. The objective of our study is to assess the usefulness of breast MRI for the evaluation of malignant invasion of the nipple-areolar complex. MATERIALS AND METHODS. 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. RESULTS. 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). CONCLUSION. 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.