Editorial by Dr. Amie Lee on Using Pre-operative MRI to Predict Potential for Nipple-Sparing Mastectomy

Amie Lee, MD

Amie Lee, MD, contributed an editorial to Radiology, the journal of the Radiological Society of North America (RSNA) titled “Nipple-sparing Mastectomy in the Era of Neoadjuvant Systemic Therapy: The Accuracy of Preoperative MRI.” Dr. Lee is an associate professor in the breast imaging division in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco.

Historically, nipple-sacrificing mastectomy was the standard of care for therapeutic mastectomy. However, the past decade has witnessed a substantial rise in nipple-sparing mastectomy, which has been shown to be safe and effective in carefully selected patients. In the editorial, Dr. Lee discusses the study by Bae and Ahn et al, in which resolution of non-mass enhancement extension to the nipple on magnetic resonance imaging (MRI) predicted the feasibility of nipple-sparing mastectomy after neoadjuvant chemotherapy​. Lee summarized the benefits of preserving the nipple-areolar complex, which include:

  • Improved patient satisfaction and quality of life
  • Enhanced aesthetic outcomes
  • Facilitating immediate breast reconstruction

Dr. Lee also details the clinical value of preoperative MRI for making this determination. “Preoperative breast MRI may be an effective tool to help guide the selection of appropriate candidates for NSM,” she writes.

Nipple-sparing mastectomy is an option for patients with tumors that do not involve the nipple-areolar complex, as determined by clinical, imaging or histologic (frozen or permanent) assessment. For tumors that do involve the nipple-areolar complex, neoadjuvant chemotherapy may be an avenue to downstage the tumor and make nipple-sparing mastectomy a possibility.

“Within the breast, neoadjuvant chemotherapy can render inoperable tumors operable and increase the possibility of breast conservation therapy,” writes Dr. Lee. “In patients electing to undergo mastectomy, neoadjuvant chemotherapy has the potential to resolve tumor involvement within the nipple-areolar complex and might render NSM feasible.”

Dr. Lee notes that research on this subject is limited, and “data on the role of neoadjuvant chemotherapy in the context of NSM are critically lacking.”

Read the entirety of Dr. Lee’s editorial, including further insight into the effectiveness of MRI for assessing response to neoadjuvant therapy in the nipple-areolar complex, in Radiology.

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