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Hard and Soft MRI Signs of Nipple-Areolar Complex Involvement in Breast Cancer
Tal Friehmann1, Hana Shpitzer2, Marva Dahan Shemesh1
1Radiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva Affiliated With The Sackler Faculty, Tel Aviv University, Tel Aviv, Israel.
Clinical Breast Cancer
|February 24, 2026
Summary
Magnetic resonance imaging (MRI) can predict nipple-areolar complex (NAC) involvement in breast cancer. Direct tumor extension and proximity under 10 mm are key indicators for NAC excision.
Area of Science:
- Oncology
- Radiology
- Breast Cancer Imaging
Background:
- Accurate preoperative assessment of nipple-areolar complex (NAC) involvement is crucial for nipple-sparing surgery in breast cancer.
- Magnetic resonance imaging (MRI) is sensitive but can be confounded by benign mimics.
Purpose of the Study:
- To identify and evaluate MRI features predictive of pathologically confirmed NAC involvement.
- To improve surgical decision-making for breast cancer patients.
Main Methods:
- Retrospective study of 78 breast cancer patients with suspected NAC involvement on preoperative MRI.
- Assessment of MRI findings including tumor morphology, tumor-to-nipple distance, ductal enhancement, and direct tumor extension.
- Logistic regression analysis to determine associations between imaging features and NAC involvement.
Main Results:
- 53% of eligible cases (31/58) had pathologically confirmed NAC involvement.
- Direct tumor extension and tumor proximity < 10 mm were most associated with NAC involvement.
- Mass-forming tumors within 10 mm of the nipple significantly increased odds of NAC involvement (OR 4.32; P = .0095), especially with ductal enhancement or hormone receptor positivity.
Conclusions:
- Direct tumor extension and short tumor-to-nipple distance are strong MRI predictors of NAC involvement, supporting NAC excision.
- "Soft signs" like ductal enhancement alone may require further workup before excluding nipple preservation.
- MRI features aid in surgical planning for breast cancer, optimizing outcomes for nipple-sparing procedures.
