Utility of Imaging in Nipple-Sparing Mastectomy

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 2.75
Patient Care: 0.75
Patient Interactions and Management: 0.75
Procedures: 2.00
Breast Interventions: 2.00

Mammography: 2.75
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 1.75
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.75

Magnetic Resonance Imaging: 2.25
Procedures: 2.25
Body: 2.25

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Thoracic Section: 2.75

Sonography: 2.00
Procedures: 2.00
Superficial Structures and Other Sonographic Procedures: 2.00

Outline

1. Introduction
2. Brief Surgical Overview of NSM
3. Imaging the NAC
   1. Mammography
   2. Ultrasonography
   3. Breast MRI
   4. Labeling and Correlating Multimodality Findings
4. Candidacy for NSM
   1. Mammographic Findings that Preclude NSM
   2. US Findings that Preclude NSM
   3. MRI Findings that Preclude NSM
5. Normal Appearance after NSM and Reconstruction versus Recurrence at Breast MRI
6. Flap Reconstruction
7. Complications after NSM and Breast Reconstruction
8. Imaging Appearance of Recurrence
9. Conclusion

Objectives

Upon completion of this course, students will:

1. state the most frequently performed surgical treatment for breast cancer
2. explain the primary concern with nipple-sparing mastectomyidentify the area of the breast in which cancers arise
3. report the percent of tumor recurrence in the nipple areolar complex
4. list positive patient outcomes associated with nipple-sparing mastectomy
5. list the contraindications for nipple-sparing mastectomy
6. list imaging findings that should raise suspicion for malignancy in the nipple areolar complex
7. choose procedures that are considered as conservative mastectomy treatment
8. describe skin-sparing mastectomy
9. explain what the pocket created during nipple-sparing mastectomy may be filled with
10. list the complications associated with nipple-sparing mastectomy
11. state the percent of nipple necrosis associated with nipple-sparing mastectomy
12. describe the normal composition of the nipple areolar complex
13. list the normal nipple shapes and sizes
14. list the mammographic limitations in evaluating the nipple areolar complex
15. choose the correct view to image breast calcifications
16. explain how to optimally image the breast at mammography
17. list US techniques utilized to obtain diagnostic images of the breast
18. recall proper US transducer placement used for the rolled-nipple technique
19. choose the imaging modality that is the most sensitive for evaluation of the nipple areolar complex because of its superior soft-tissue contrast and the addition of contrast enhancement
20. state when nipple enhancement is best assessed during MRI
21. explain the appearance and display of nipples at MRI
22. list the four categories of nipple enhancement at MRI
23. describe areolar thickening appearance at MRI
24. list the patient position for breast imaging in multiple modalities
25. explain how to accurately communicate the location and findings of breast disease
26. choose which imaging modality has been found to be beneficial before nipple-sparing mastectomy for better visualization of the retroareolar tissue, identification of malignancy, and accurate measurement of the tumor to nipple distance
27. list the factors that are highly suggestive of malignancy involving the nipple areolar complex at mammography
28. list the type of masses found in the retroareolar location of the breast
29. describe common signs of breast malignancy as they relate to the nipple
30. explain where nipple areolar complex calcifications can be found in the breast
31. choose the views and imaging modalities that can be helpful in determining whether calcifications appear benign or have morphologic characteristics that are suspicious for cancer
32. explain how breast malignancies may appear at US
33. choose the modality that is the most useful for accurately predicting nipple areolar complex involvement in malignancy
34. recall authors of studies that have investigated the use of breast MRI for prediction of neoplastic involvement of the nipple areolar complex
35. describe abnormal nipple enhancement at MRI
36. describe breast tumor invasion
37. state the tumor to nipple distance seen at MRI that indicates a high possibility of malignancy in the nipple areolar complexunderstand the common breast reconstruction techniques
38. know which modality is superior in imaging breast flap reconstruction
39. recall the skin flap thickness that is associated with a greater number of terminal duct units and the presence of residual disease
40. list the complications seen within the first 6 months following breast surgery and autologous reconstruction
41. describe the mammographic manifestations of recurrent breast cancer