ARRS 2022 Abstracts

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E1141. The Nipple Areolar Complex: A Radiologist’s Guide to Key Anatomy, Imaging, and Physical Exam Findings and Pathology
Authors
  1. Jordan Burner; Wake Forest Baptist Health
  2. Margaret Yacobozzi; Wake Forest Baptist Health
  3. Kelly Brozzetti Cronin; Wake Forest Baptist Health
Background
The nipple, areola, and the subareolar structures including adjacent sinuses and ducts are important anatomic features of the breast, collectively referred to as the nipple areolar complex (NAC). Despite the NAC being a critical functional unit of the breast and encountered in many breast exams, misinterpretation of clinical history, physical exam, and imaging findings can lead to inaccurate diagnoses and unnecessary biopsies and follow-up.

Educational Goals / Teaching Points
The NAC remains a challenging diagnostic area for many radiologists, including breast imagers. This educational exhibit will serve practicing radiologists to improve their diagnostic accuracy and simplify their work-up. This exhibit will encompass important physical exam findings and techniques to evaluate the NAC, including adequate ductal expression, selection of appropriate imaging modalities, and successful differentiation between normal, benign, and suspicious findings. This will be achieved through multiple cases demonstrating key pathology of the NAC. Case examples will include mammogram, ultrasound, MRI, and ductography images. We will also briefly discuss postsurgical findings and complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key anatomic differentiating features to recognize include skin abnormalities as well as nipple retraction and inversion with attention to its associated time course, laterality, and recognition on physical exam and mammogram. Additionally, nipple discharge including the type of discharge, number of ducts involved, laterality, and time of onset will guide clinical and imaging management. We will review benign pathologies, subcategorized into inflammation (such as eczema, psoriasis, and dermatitis), infectious (such as candidiasis, mastitis, and abscess), galactoceles, and intraductal lesions (such as papilloma), and mammary duct ectasia. We will review malignant pathologies to include Paget disease, associations with DCIS, and invasive ductal carcinoma. Postsurgically, it is important to recognize signs of nipple necrosis as well as postoperative fluid collections and infections.

Conclusion
The NAC is an anatomic landmark every radiologist who practices breast imaging will encounter, and yet confidence in diagnosing and managing its pathology remains challenging for many. When the radiologist understands the underlying anatomy as well as how to perform a focused physical exam and history, appropriate imaging selection and interpretation can be both simplified and improved. This will lead to suitable treatment and better care for patients.