Performance of contrast-enhanced cone-beam breast CT to predict nipple-areolar complex involvement in early-stage...

To evaluate the diagnostic performance of preoperative contrast-enhanced cone-beam breast CT (CE-CBBCT) and identify significant predictors of nipple-areolar complex (NAC) involvement in early-stage breast cancer patients.

This retrospective study included 641 breast cancer cases from 631 patients at Sun Yat-sen University Cancer Center (2019.3-2021.3). From these, 182 cases were selected after one-by-one matching with the NAC involvement group using the propensity score matching method. Two radiologists independently assessed CE-CBBCT imaging factors in 182 cases. Diagnostic performance indices were analyzed, and predictors of NAC involvement in breast cancer were identified using logistic regression analyses.

The 182 matched cases were females with a median age of 50 (interquartile range, 44-55; range, 25-81 years). Interobserver agreement regarding CBBCT prediction by two radiologists was relatively substantial (κ = 0.730). The accuracy of radiologists in predicting NAC involvement in CE-CBBCT was 83.52% (152/182), with a sensitivity of 96.70% (88/91), specificity of 70.33% (64/91), negative predictive value of 95.52% (64/67), and positive predictive value (PPV) of 76.52% (88/115). On CE-CBBCT, asymmetric NAC enhancement (odds ratio, 5.279; p = 0.001) and TNE (tumor-nipple enhancement) within 2 cm of the NAC (odds ratio, 4.184; p = 0.02) were significant predictors of NAC involvement. When asymmetric NAC enhancement and TNE extending to the NAC were present, the PPV was 82.35% (56/68).

CE-CBBCT is a safe and non-invasive modality with comparably high accuracy for the preoperative diagnosis of NAC involvement. Asymmetric NAC enhancement and TNE within 2 cm of the NAC performed well in predicting NAC involvement.

Question Several imaging modalities have been studied to preoperatively evaluate NAC involvement, but CE-CBBCT's performance was unknown. Findings CE-CBBCT showed high accuracy in diagnosing NAC involvement. Asymmetric NAC enhancement and tumor-nipple enhancement within 2 cm of the NAC were independent predictors of NAC involvement. Clinical relevance CE-CBBCT can serve as a safe, non-invasive modality to diagnose NAC involvement preoperatively and help to identify candidates for nipple-sparing mastectomy.