Resolution of Nonmass Enhancement Extension to the Nipple at Breast MRI after Neoadjuvant Chemotherapy: Pathologic Response and Feasibility for Nipple-sparing Mastectomy.

Autor:	Bae SJ; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Ahn SG; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Park EJ; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Eun NL; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Kim JH; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Ji JH; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Kook Y; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Jang JS; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Baek SH; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Cha YJ; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.)., Jeong J; From the Department of Surgery (S.J.B., S.G.A., E.J.P., Y.K., J.S.J., S.H.B., J.J.), Department of Radiology (N.L.E.), Division of Medical Oncology, Department of Internal Medicine (J.H.K.), and Department of Pathology (Y.J.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea; Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (S.J.B., S.G.A., J.H.K., Y.K., J.S.J., S.H.B., Y.J.C., J.J.); and Department of Surgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (J.H.J.).
Jazyk:	angličtina
Zdroj:	Radiology [Radiology] 2023 Apr; Vol. 307 (2), pp. e221777. Date of Electronic Publication: 2023 Feb 07.
DOI:	10.1148/radiol.221777
Abstrakt:	Background Nipple-sparing mastectomy (NSM) is usually contraindicated in patients with nonmass enhancement (NME) extension to the nipple at breast MRI. However, little is known about the feasibility of NSM when NME extension to the nipple resolves after neoadjuvant chemotherapy (NAC). Purpose To evaluate whether NSM is an appropriate surgical procedure for patients in whom NME extension to the nipple resolves after NAC. Materials and Methods This retrospective study included 383 women with NME at baseline MRI who underwent NAC followed by mastectomy between January 2007 and March 2022 at a single institution. NME extension to the nipple was assessed using breast MRI before NAC (hereafter, pre-NAC) and after NAC (hereafter, post-NAC). In 326 women who underwent mastectomy with removal of the nipple-areolar complex, the rate of pathologic analysis-confirmed tumor invasion of the nipple compared with NME extension to the nipple at post-NAC breast MRI was evaluated. Tumor involvement of the nipple was also assessed in those with complete pathologic response at posttreatment MRI. Furthermore, the outcomes in 57 women undergoing NSM were investigated, particularly in patients with NME extension to the nipple at initial diagnosis. Results Of the 326 women who underwent mastectomy with removal of the nipple-areolar complex (mean age, 49 years ± 9.4 [SD]), 217 patients (67%) showed NME extension to the nipple on pre-NAC MRI scans. Among the 153 women (70%) in whom the NME extension to the nipple resolved after NAC, the rate of pathologic analysis-confirmed tumor invasion of the nipple was 2.6% (four of 153 women; 95% CI: 0, 6.5). No pathologic analysis-confirmed tumor invasion of the nipple was detected in 31 women with complete response at MRI. Of the 57 women who underwent NSM, 12 (21%) with resolution of NME extension to the nipple after NAC had no relapse during the median follow-up of 31 months (range, 11-80 months). Conclusion Pathologic analysis-confirmed tumor invasion of the nipple was rare in women with resolution of nonmass enhancement extension to the nipple after neoadjuvant chemotherapy (NAC). Therefore, nipple-sparing mastectomy could be feasible in this population, especially in those with complete MRI response to NAC. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Lee in this issue.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu