Tumor-Nipple Distance of ≥ 1 cm Predicts Negative Nipple Pathology After Neoadjuvant Chemotherapy.

BACKGROUND: As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS-) in women undergoing total mastectomy after NAC. METHODS: Women with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS- was examined and the accuracy of 1 cm TND on imaging for predicting NS- was determined. RESULTS: Among 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement (p < 0.05). The likelihood of NS- was higher with increasing TND on pre- and post-NAC imaging (p < 0.05). TND ≥ 1 cm predicted NS- in 97% and 95% of breasts on pre- and post-NAC imaging, respectively. CONCLUSIONS: Increasing TND was associated with a higher likelihood of NS-. A TND ≥ 1 cm on pre- or post-NAC imaging is highly predictive of NS- and could be used to determine eligibility for nipple-sparing mastectomy after NAC.

Is It the Era for Personalized Screening?

Breast cancer screening is a recognized tool for early detection of the disease in asymptomatic women, improving treatment efficacy and reducing the mortality rate. There is raised awareness that a "one-size-fits-all" approach cannot be applied for breast cancer screening. Currently, despite specific guidelines for a minority of women who are at very high risk of breast cancer, all other women are still treated alike. This article reviews the current recommendations for breast cancer risk assessment and breast cancer screening in average-risk and higher-than-average-risk women. Also discussed are new developments and future perspectives for personalized breast cancer screening.

IDIOPATHIC GRANULOMATOUS MASTITIS: DIAGNOSIS AND FOLLOW-UP WITH MAGNETIC RESONANCE IMAGING / Mastite granulomatosa idiopática: diagnóstico e seguimento com ressonância magnética

Granulomatous mastitis is a rare and benign condition of the breast that, in some cases, has an unknown etiology of benign inflammatory disease know as idiopathic mastitis. Your diagnosis is usually made by exclusion. Imaging tests have shown nonspecific findings that may suggest an inflammatory disease, a carcinoma, or no changes. A differential diagnosis should be made with other causes of mastitis, always alerting to the risk of inflammatory carcinoma. Imaging tests are more useful to rule out malignancy than to confirm idiopathic granulomatous mastitis. Because both imaging and physical examination can mimic a malignant lesion of the breast, the histopathological report is fundamental to establish the diagnosis. Its etiology remains unknown, so the treatment is controversial in the literature, with some authors recommending surgery, others immunosuppression, and, finally, some antibiotics. We report the case of a 21-year-old woman with a suspected lesion in the breast associated with papillary discharge. During the investigation, there was a 12 x 6 x 8.5 cm enhancement on magnetic resonance imaging associated with inflammatory signs on the skin and lymph nodes. Anatomopathological examination revealed a idiopathic granulomatous mastitis. The enhancement disappeared completely after conservative treatment with corticosteroids. Mammography and ultrasound may also demonstrate nonspecific changes, such as focal asymmetry, undefined mass, or distortion. Despite the limitations of the imaging studies, it has been demonstrated in this report that MRI can be used to monitor the clinical response to conservative treatment and follow-up by the risk of recurrence.

A mastite granulomatosa é uma condição rara e benigna da mama que, em alguns casos, possui etiologia desconhecida de doença inflamatória benigna, a mastite idiopática. Seu diagnóstico normalmente é feito por exclusão. Os exames de imagens têm demonstrado achados inespecíficos que podem sugerir uma doença inflamatória, um carcinoma ou não apresentar alterações. Deve ser realizado um diagnóstico diferencial com outras causas de mastites, sempre alertando para o risco de carcinoma inflamatório. Os exames de imagem servem mais para descartar uma malignidade do que para confirmar a mastite granulomatosa idiopática. Em função de tanto os exames de imagem como o exame físico poderem simular uma lesão maligna da mama, o laudo histopatológico é fundamental para estabelecer o diagnóstico. A sua etiologia permanece desconhecida, portanto, o tratamento é controverso na literatura, com alguns autores recomendando cirurgia, outros a imunossupressão e, por fim, alguns antibióticos. É apresentado o caso de uma paciente de 21 anos com uma lesão suspeita na mama associada à descarga papilar. Durante a investigação, houve um realce de 12 x 6 x 8,5 cm na ressonância magnética associado a sinais inflamatórios na pele e nos linfonodos. O exame anatomopatológico evidenciou um quadro de mastite granulomatosa idiopática. O realce desapareceu completamente após o tratamento conservador com corticoterapia. A mamografia e o ultrassom também podem demonstrar alterações inespecíficas, tais como assimetria focal, massa indefinida ou distorção. Apesar das limitações dos exames de imagem, demonstrou-se, neste relato, que a ressonância magnética pode ser utilizada para monitorar a resposta clínica ao tratamento conservador e o acompanhamento pelo risco de recorrência.