scholarly journals Use of preoperative mammography, ultrasonography, and MRI to predict nipple areolar complex involvement in breast cancer

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190074 ◽  
Author(s):  
Soyeoun Lim ◽  
Gyeongmin Park ◽  
Hye-jeong Choi ◽  
Woon Jung Kwon ◽  
Byeong Seong Kang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymphovascular Invasion ◽  
Perineural Invasion ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Imaging Findings ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
Imaging Results ◽  
Relation Type

Objective: To identify the predictive factors of cancer invading into the nipple. Methods: Patients with breast cancer undergoing mastectomy between May 2009 and March 2019 were reviewed retrospectively. Of these, those with breast cancer within 2 cm of the nipple areolar complex on ultrasonography were included in this study. Clinicopathological data of the primary tumor and imaging findings from mammography, ultrasonography, and MRI were compared between cases with and without nipple involvement by cancer. Results: In total, 156 of the 821 patients identified were included in the analysis. Of them, 29 had nipple involvement by cancer. Univariate analysis revealed that the following imaging results were significantly associated with nipple involvement: perineural invasion, lymphovascular invasion, lymph node metastasis; relation type between the tumor and the nipple on ultrasonography; periareolar skin thickening on mammography; and short tumor-nipple distance, continuous enhancement between the nipple and tumor, skin enhancement, and nipple enhancement on MRI. However, on multivariate logistic regression analysis, only invasion type of tumor on ultrasonography and nipple enhancement and short tumor-nipple distance on MRI were significantly correlated with nipple involvement by cancer. Conclusion: Imaging findings on preoperative mammography, ultrasonography and MRI are effective predictors for nipple involvement by cancer. Advances in knowledge: Preoperative mammography, ultrasonography, and MRI help predict nipple involvement by breast cancer.

Invasive Mammary Paget Disease Without an Underlying Breast Cancer: A Case Report

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S43-S44 ◽  
Author(s):  
Alexis Bousamra ◽  
Nazia Khatoon ◽  
Ariel Sandhu ◽  
Jan Silverman ◽  
Mary Beth Malay
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Ductal Carcinoma ◽  
Malignant Lesion ◽  
Sentinel Lymph Nodes ◽  
Fish Analysis ◽  
Nipple Areolar Complex ◽  
Paget Disease ◽  
Areolar Complex ◽  
Skin Punch Biopsy

Abstract Mammary Paget disease (MPD) is a malignant lesion of the nipple-areolar complex and considered an intraepidermal sign of an underlying invasive or in situ carcinoma. In rare instances, mammary Paget cells can invade the dermis. Comprehensive literature review identified 33 such cases. Here, we report a case of a 48-year-old female with invasive MPD, without an associated underlying breast cancer. Only five such presentations are reported. With a presentation of right nipple-areolar excoriation for 2 years, skin punch biopsy was performed and reported as “Paget disease.” Further evaluation with bilateral mammograms failed to show any primary mass or calcifications. Bilateral breast MRI revealed focal nonmass enhancement in upper outer quadrant in both breast, the biopsy of which showed benign breast tissue. Right breast nipple areolar complex resection demonstrated MPD extensively involving the epidermis. Multiple foci of invasive ductal carcinoma are present, growing downward into the nipple dermis, the largest focus being 0.2 cm in greatest dimension. No lymphovascular invasion is identified. The mammary Paget cells are positive for Cam 5.2 and epithelial membrane antigen (EMA) and negative for keratins 7 and 20. The invasive tumor cells are strongly positive for estrogen receptor (100%) and progesterone receptor (75%) and equivocal (2+) for Her2/Neu. FISH analysis showed amplification for HER2 (HER2/CEP17 ratio: 2.75). Four right axillary sentinel lymph nodes are negative for carcinoma. Two of the five patients with invasive MPD described in the literature, and without underlying breast cancer, had a sentinel lymph node biopsy performed. Isolated tumor clusters were present in one of these two cases. In summary, we describe a rare case of invasive MPD without an underlying breast cancer. Although sentinel lymph nodes are important to assess metastasis, further cases are required to evaluate the significance and prognosis of this rare entity.

MRI diagnostic features for predicting nipple-areolar-complex involvement in breast cancer

2020 ◽  
Vol 122 ◽  
pp. 108754 ◽  
Author(s):  
Jieun Koh ◽  
Ah Young Park ◽  
Kyung Hee Ko ◽  
Hae Kyoung Jung
Keyword(s):  
Breast Cancer ◽  
Diagnostic Features ◽  
Nipple Areolar Complex ◽  
Areolar Complex

scholarly journals Oncoplastic breast surgery technique for retroareolar breast cancer: a technical modification of the Grisotti flap in patients with short nipple to inferior mammary crease distance

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Miguel Johnson ◽  
Lorna Cook ◽  
Fabio I Rapisarda ◽  
Dibendu Betal ◽  
Riccardo Bonomi
Keyword(s):  
Breast Cancer ◽  
Primary Closure ◽  
Breast Surgery ◽  
Breast Conservation ◽  
Original Description ◽  
Breast Conservation Surgery ◽  
Oncoplastic Breast Surgery ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
Conservation Surgery

ABSTRACT The introduction of breast conservation surgery together with advances in oncoplastic techniques has revolutionized the management of retroareolar breast tumours. Traditionally, cancers in this location were often managed with central excision and primary closure or mastectomy. More recently, oncoplastic breast-conserving techniques such as the Grisotti mammoplasty have been increasingly encouraged as an alternative option as it allows oncological safe margin resections while restoring cosmesis. The use of a Grisotti flap enables safe resection of a retroareolar tumour with concurrent reconstruction of the defect using a local rotational advancement dermoglandular flap allowing a satisfactory cosmetic result in term of contour and projection. This technique is often limited to those patients with sufficient native nipple-inferior mammary fold (IMF) distance to accommodate for some inevitable post-operative reduction in this distance. We describe a modification of the original description, such that satisfactory cosmetic outcome can be achieved, even in patients with a short nipple areolar complex to inframammary fold distance.

Comparison of terminal duct lobular units in the nipple areolar complex by tumor subtypes-the implication for nipple sparing mastectomy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12082-e12082
Author(s):  
Kenna Schnarr ◽  
Fang Fan ◽  
Amanda Leigh Amin ◽  
Christa Balanoff ◽  
Joshua Mammen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Statistical Significance ◽  
Breast Cancer Subtype ◽  
Tumor Subtype ◽  
Luminal B ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
Significant Difference ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

e12082 Background: Nipple-sparing mastectomy (NSM) has gained popularity for surgical treatment of breast cancer. Terminal duct lobular units (TDLU) have been shown to be present in 25% of nipple areolar complex (NAC). Pathologic tumor subtype influence on presence of TDLU in the NAC has not been assessed. In addition, criteria for technically performing the dissection below the NAC have not been established. We sought to evaluate TDLU characteristics by tumor subtype and determine NSM dissection criteria below the NAC. Methods: A retrospective review was performed of 120 total and skin sparing mastectomies, 30 of each breast cancer subtype, from 1/2013 to 1/2015. The NAC of each mastectomy was assessed for number of TDLU and distance from TDLU to the skin. Results: Thirty of the 120 mastectomies (25%) had TDLU present below the NAC. Of the 30 with TDLU, there was no statistically significant difference in number of TDLU present based on tumor grade (gd) (gd 1 vs 2, p = .67; gd 1 vs 3, p = .24). Compared to luminal A, luminal B showed statistical significance (p < .05) for number of TDLU at the NAC whereas Her 2 and triple negative breast cancer (TNBC) were not statistically significant (p = .09 and .10). In mastectomies with TDLU present, gd 2 (p < .05) and gd 3 (p = .05) had a closer skin distance than gd 1. When compared by tumor subtype, there was no difference in TDLU to skin distance (table). Conclusions: NSM has been adopted as a safe oncologic approach to breast cancer treatment. Although presence of TDLU in luminal B subtype was statistically significant, this may not be clinically significant, as there were only 2 of 30 cases with TDLU. Our study indicates that a careful dissection at the level of the dermis below the NAC is necessary, as 25% of women will have TDLU present. This will provide an appropriate oncologic outcome similar to total and skin sparing mastectomy. Tumor subtype does not appear to be exclusion criteria for NSM. However, more aggressive dissection may be necessary to clear all TDLU from below the NAC in higher gd cancers. [Table: see text]

scholarly journals Prognostic Factors on the Positivity for Metastases of the Axillary Lymph Nodes from Primary Breast Cancer

PRILOZI ◽  
2017 ◽  
Vol 38 (1) ◽  
pp. 81-90
Author(s):  
Borislav Kondov ◽  
Goran Kondov ◽  
Zoran Spirovski ◽  
Zvonko Milenkovikj ◽  
Risto Colanceski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Lymph Nodes ◽  
Primary Breast Cancer ◽  
Lymphovascular Invasion ◽  
Treated Patient ◽  
Univariate Analysis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
The Impact

Abstract Aim: The aim of the study was to identify the impact of T stage, the presence of estrogen, progesterone, HER2neu receptors and the values of the Ki67 on the positivity for metastases of the axillary lymph nodes, from primary breast cancer. Material and methods: 290 surgically treated patients for breast cancer were included in the study. All cases have been analyzed by standard histological analysis including microscopic analysis on standard H&E staining. For determining the molecular receptors - HER2neu, ER, PR, p53 and Ki67, immunostaining by PT LINK immunoperoxidase has been done. Results: Patients age was ranged between 18-90 years, average of 57.6+11.9. The mean size of the primary tumor in the surgically treated patient was 30.27 + 18.3 mm. On dissection from the axillary pits 8 to 39 lymph nodes were taken out, an average of 13.81+5.56. Metastases have been found in 1 to 23 lymph nodes, an average 3.14+4.71. In 59% of the patients there have been found metastases in the axillary lymph nodes. The univariate regression analysis showed that the location, size of tumor, differentiation of the tumor, stage, the value of the Ki67 and presence of lymphovascular invasion influence on the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors and HER2neu receptors showed that they do not have influence on the positivity for metastatic deposits in axillary lymph nodes. The multivariate model and the logistic regression analysis as independent significant factors or predictors of positivity of the axillary lymph nodes are influenced by the tumor size and the positive lymphovascular invasion. Conclusion: Our study showed that the involving of the axillary lymph nodes is mainly influenced by the size of the tumor and the presence of lymphovascular invasion in the tumor. Ki67 determined proliferative index in the univariate analysis points the important influence of positivity in the axillary lymph nodes, but not in the multivariate regressive analysis.

Association of higher proliferation of Ki67 with unfavorable prognostic factors and shorter survival in breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11083-e11083
Author(s):  
Saadettin Kilickap ◽  
Yalcin Kaya ◽  
Birsen Yucel ◽  
Ersin Tuncer ◽  
Sahande Elagoz
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Lymphovascular Invasion ◽  
Perineural Invasion ◽  
Lymph Node Involvement ◽  
Free Survival ◽  
Ki67 Expression ◽  
Node Involvement ◽  
The Mean ◽  
Estrogen Receptor Negativity

e11083 Background: The prognostic value of Ki67 expression level is yet unclear in breast cancer (BC). The aim of this study was to investigate the association between Ki67 expression levels and other prognostic factors in BC. Methods: Demographic, clinical and pathological features of the pts were retreived from the hospital records. Results: In this study, 163 pts with BC were analyzed. The mean age of the pts was 53.4±12.2 years. Median Ki67 level was 20% in this study. Ki67-high tumors were significantly associated with high grade (p<0.001), lymphovascular invasion (p=0.001), estrogen receptor negativity (ER-) (p=0.035), Her2 (+) (p=0.001), advanced stage (p<0.001) and lymph node involvement (LNI) (p<0.003) of the tumor. There was no relationship between the age, perineural invasion, progesterone receptor and Ki67 positivity. Lower Ki67 levels were significantly associated with longer median relaps-free survival (RFS) compared to those of higher Ki67 levels (p=0.008). The overall survival (OS) was longer in pts with lower Ki67 levels than those with higher levels (p=0.017). Conclusions: High Ki67 expression was associated with ER-, Her2 (+), higher grade and LNI in BC. The level of Ki67 expression was a prognostic factor predicting the RFS and OS in BC pts. [Table: see text]

scholarly journals Prediction of nipple-areolar complex involvement by breast cancer: role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mohamed Ali EL-Adalany ◽  
Ahmed Abd El-Khalek Abd EL-Razek ◽  
Dina EL-Metwally
Keyword(s):  
Breast Cancer ◽  
Radical Mastectomy ◽  
Breast Mri ◽  
Preoperative Assessment ◽  
Dce Mri ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
Mri Features ◽  
Nipple Sparing

Abstract Background Skin-sparing and nipple-sparing mastectomies were considered as alternative techniques for modified radical mastectomy. In patients who are candidates for nipple-sparing mastectomy, preoperative assessment of the nipple-areolar complex (NAC) is essential for adequate surgical planning. Breast MRI is highly sensitive for cancer detection and has an important role in disease staging. The aim of this study was to estimate the role of DCE-MRI in predicting malignant NAC invasion by underlying breast cancer and assess the best predictors on MRI that can suspect malignant NAC invasion. Results Out of the 125 patients with breast cancer, 33 patients (26.4%) showed malignant NAC invasion. On basis of multivariate analysis, abnormal nipple enhancement, tumor nipple enhancement, tumor nipple distance ≤ 2 cm, and abnormal and asymmetric nipple morphology were all significant predictors of malignant NAC invasion (P < 0.001) with abnormal unilateral nipple enhancement as the most important independent MRI predictor of malignant NAC invasion (odds ratio = 61.07, 95% CI 12.81–291.22, P < 0.001). When combining more than positive suspicious MRI features, DCE-MRI had 66.6% sensitivity, 76% specificity, 50% PPV, 86.4% NPV, and 73.6% accuracy in prediction of malignant NAC invasion. Conclusion DCE-MRI could predict malignant NAC invasion with abnormal unilateral nipple enhancement as the most important independent MRI predictor.

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