Nipple Enhancement at Breast MRI with Radiologic-Pathologic Correlation

Yiming Gao , Elena F. Brachtel, Osvaldo Hernandez, Samantha L. Heller

Author Affiliations

• From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.).
• Address correspondence to Y.G.(e-mail: yiming.gao@nyumc.org).

Published Online:Dec 14 2018https://doi.org/10.1148/rg.2019180039

See Invited Commentary byMichael A. Cohen

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Abstract

Enhancement of the normal nipple at breast MRI is reviewed on the basis of findings in healthy individuals and at radiologic-pathologic correlation.

Breast MRI is the most sensitive imaging modality for assessment of the nipple-areola complex (NAC), which is important both in cancer staging and in high-risk screening. However, the normal appearance of the nipple at MRI is not well defined because of a paucity of scientific literature on this topic. Hence, there is a lack of descriptive terminology and diagnostic criteria, which may account for the wide variability in interpretation among radiologists when assessing the NAC on MR images. In light of the current shift toward possible expanded use of abbreviated (ie, fast) breast MRI for screening in women at average risk for cancer in particular, and because an increasing number of women now undergo nipple-sparing mastectomy for therapeutic and/or prophylactic indications, careful assessment of the NAC at MRI is essential. In this article, the normal pattern of nipple enhancement at MRI is defined on the basis of findings observed in healthy individuals, normal nipple enhancement at MRI is correlated with the structural anatomy of the nipple at histopathologic analysis, and artifacts and pitfalls related to MRI of the NAC are reviewed. Understanding the normal range of nipple morphology and enhancement at MRI is important, as it enables radiologists to better differentiate between normal and abnormal nipple findings with increased diagnostic confidence.