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Katouli FS, Bayani L, Azizinik F, Fathi S, Seifollahi A, Bozorgabadi FZ. Spectrum of ultrasound findings in patients with history of breast conservative treatment. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1381-1389. [PMID: 37526634 DOI: 10.1002/jcu.23524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
Breast conservative treatment (BCT) is currently accepted as the standard treatment option for breast cancer. Targeted ultrasound helps detect recurrent lesions, postoperative changes, and scarring tissue. In this pictorial essay, we review the ultrasound features of benign (seroma, hematoma, fat necrosis, traumatic neuroma, fibrosis/scarring) and malignant (recurrence, new primary cancer) causes of palpable lumps after BCT and provide images from our patients to illustrate some typical findings of common pathologies. Ultrasound, especially as an adjunct to mammography, can make a specific diagnosis in most cases.
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Affiliation(s)
- Fatemeh Shakki Katouli
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Bayani
- Department of Radiology, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Azizinik
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Amiralam and Yas Hospitals, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Fathi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Seifollahi
- Pathology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zare Bozorgabadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Li JK, Fu NQ, Wang B, Jiang Y, Li SY, Niu RL, Wang ZL. Conventional ultrasound combined with contrast-enhanced ultrasound: could it be helpful for the diagnosis of thoracic wall recurrence after mastectomy? Eur Radiol 2023; 33:6482-6491. [PMID: 37074423 DOI: 10.1007/s00330-023-09594-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To develop a predictive model using conventional ultrasound combined with CEUS to identify thoracic wall recurrence after mastectomy. METHODS A total of 162 women with pathologically confirmed thoracic wall lesions (benign 79, malignant 83; median size 1.9 cm, ranging 0.3-8.0 cm) underwent a mastectomy and were checked by both conventional ultrasound and CEUS and were retrospectively included. Logistic regression models of B-mode ultrasound (US) and color Doppler flow imaging (CDFI) with or without CEUS were established to assess the thoracic wall recurrence after mastectomy. The established models were validated by bootstrap resampling. The models were evaluated using calibration curve. The clinical benefit of models were assessed using decision curve analysis. RESULTS The area under the receiver characteristic was 0.823 (95% CI: 0.76, 0.88) for model using US alone, 0.898 (95% CI: 0.84, 0.94) for model using US combined with CDFI, and 0.959 (95% CI: 0.92, 0.98) for model using US combined with both CDFI and CEUS. The diagnostic performance of the US combined with CDFI was significantly higher than that of the US alone (0.823 vs 0.898, p = 0.002) but significantly lower than that of the US combined with both CDFI and CEUS (0.959 vs 0.898, p < 0.001). Moreover, the unnecessary biopsy rate of the US combined with both CDFI and CEUS was significantly lower than that of the US combined with CDFI (p = 0.037). CONCLUSIONS Compared to B-mode ultrasound and CDFI, CEUS improves the diagnostic performance to evaluate thoracic wall recurrence after mastectomy. KEY POINTS • CUES is an effective supplementary method for US in the diagnosis of thoracic wall recurrence after mastectomy. • CEUS combined with both US and CDFI can significantly improve the accuracy of diagnosis of thoracic wall recurrence after mastectomy. • CEUS combined with both US and CDFI can reduce the rate of unnecessary biopsy of thoracic wall lesions after mastectomy.
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Affiliation(s)
- Jun Kang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Department of Ultrasound, Chinese PLA 63820 Hospital, Mianyang, Sichuan, China
| | - Nai Qin Fu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Bo Wang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ying Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shi Yu Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Rui Lan Niu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi Li Wang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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3
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Chung HL, Bragg AC, Shin K, Speer ME, Sun J, Leung JWT. Diagnostic ultrasound of the chest wall in the symptomatic patient after mastectomy. Clin Imaging 2023; 101:126-132. [PMID: 37331150 DOI: 10.1016/j.clinimag.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Lack of standardized imaging recommendations among mastectomy patients has led to variability in how recurrences are detected. OBJECTIVE To describe the findings and assess the diagnostic efficacy of ultrasound in the evaluation of symptomatic post-mastectomy patients. MATERIALS AND METHODS This single institution, retrospective study included 749 consecutive diagnostic chest wall ultrasound examinations performed in mastectomy patients, from January 2016 to June 2017. Chest wall ultrasound evaluated the mastectomy bed with or without reconstruction. Electronic health records were queried for the primary breast cancer histology prior to mastectomy, clinical symptoms prompting the diagnostic ultrasound, ultrasound findings, subsequent cytology and pathology, and follow-up data. Excluded were patients with a known recurrence, asymptomatic patients, and those with <2 years of clinical or imaging follow-up. Descriptive and comparative statistical analyses were performed. RESULTS Among the 749 ultrasounds performed, 58 malignancies were identified for a 7.7% (58/749) malignancy rate, with a median tumor size of 20 mm. Patients diagnosed with a malignancy most often presented with a palpable abnormality (79.3%, 46/58) or skin changes (13.8%, 8/58) and rarely with pain (1.7%, 1/58). Patients who underwent a biopsy yielding a benign result most often presented with a palpable abnormality (41.5%, 287/691), pain (25.6%,177/691), or postoperative swelling/suspected fluid collection (17.8%, 123/691). Diagnostic ultrasound yielded a 91.4% sensitivity (95% CI 81.0, 97.1), 96.1% specificity (95% CI 94.4, 97.4), 66.3% PPV3 (95% CI 57.4, 74.1), and 99.3% negative predictive value (95% CI 98.3, 99.7) for cancer detection. There were 5 false negative ultrasound cases after a skin punch biopsy was performed due to clinically suspicious skin changes. CONCLUSIONS Chest wall ultrasound has a high sensitivity and negative predictive value for detection of breast cancer recurrence in symptomatic patients after mastectomy. Skin changes remain an important clinical manifestation of a cancer recurrence.
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Affiliation(s)
- Hannah L Chung
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, 1515 Holcombe Blvd, CPB5.3201, Houston, TX 77030, United States of America.
| | - Ashley C Bragg
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, 1515 Holcombe Blvd, CPB5.3201, Houston, TX 77030, United States of America.
| | - Kyugmin Shin
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, 1515 Holcombe Blvd, CPB5.3201, Houston, TX 77030, United States of America.
| | - Megan E Speer
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, 1515 Holcombe Blvd, CPB5.3201, Houston, TX 77030, United States of America.
| | - Jia Sun
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, 1400 Pressler Street, FCT4.6000, Houston, TX 77030, United States of America.
| | - Jessica W T Leung
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, 1515 Holcombe Blvd, CPB5.3201, Houston, TX 77030, United States of America.
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Smith D, Sepehr S, Karakatsanis A, Strand F, Valachis A. Yield of Surveillance Imaging After Mastectomy With or Without Reconstruction for Patients With Prior Breast Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2244212. [PMID: 36454573 PMCID: PMC9716401 DOI: 10.1001/jamanetworkopen.2022.44212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE A discrepancy on current guidelines and clinical practice exists regarding routine imaging surveillance after mastectomy, mainly regarding the lack of adequate evidence for imaging in this setting. OBJECTIVE To investigate the usefulness of imaging surveillance in terms of cancer detection and interval cancer rates after mastectomy with or without reconstruction for patients with prior breast cancer. DATA SOURCES A comprehensive literature search was conducted in 3 electronic databases-PubMed, ISI Web of Science, and Scopus-without year restriction. References from relevant reviews and eligible studies were also manually searched. STUDY SELECTION Eligible studies were defined as those conducting surveillance imaging (mammography, ultrasonography, or magnetic resonance imaging [MRI]) of patients with prior breast cancer after mastectomy with or without reconstruction that presented adequate data to calculate cancer detection rates for each surveillance method. DATA EXTRACTION AND SYNTHESIS Independent data extraction by 2 investigators with consensus on discrepant results was performed. A quality assessment of studies was performed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) template. The generalized linear mixed model framework with both fixed-effects and random-effects models was used to meta-analyze the proportion of cases across studies including 3 variables: surveillance method, reconstruction after mastectomy, and surveillance measure. MAIN OUTCOMES AND MEASURES Three outcome measures were calculated for each eligible study and each surveillance imaging method within studies: overall cancer detection (defined as ipsilateral cancer, both palpable and nonpalpable) rate per 1000 examinations, clinically occult (nonpalpable) cancer detection rate per 1000 examinations, and interval cancer rate per 1000 examinations. RESULTS In total, 16 studies were eligible for the meta-analysis. The pooled overall cancer detection rates per 1000 examinations were 1.86 (95% CI, 1.05-3.30) for mammography, 2.66 (95% CI, 1.48-4.76) for ultrasonography, and 5.17 (95% CI, 1.49-17.75) for MRI. For mastectomy without reconstruction, the rate of clinically occult (nonpalpable) cancer per 1000 examinations (2.96; 95% CI, 1.38-6.32) and the interval cancer rate per 1000 examinations (3.73; 95% CI, 0.84-3.98) were lower than the overall cancer detection rate (including both palpable and nonpalpable lesions) per 1000 examinations (6.41; 95% CI, 3.09-13.25) across all imaging modalities. The interval cancer rate per 1000 examinations for mastectomy with reconstruction (3.73; 95% CI, 0.41-2.73) was comparable to the pooled cancer detection rate per 1000 examinations (4.73; 95% CI, 2.32-9.63) across all imaging modalities. In all clinical scenarios and imaging modalities, lower rates of clinically occult cancer compared with cancer detection rates were observed. CONCLUSIONS AND RELEVANCE Lower detection rates of clinically occult-compared with overall-cancer across all 3 imaging modalities challenge the use of imaging surveillance after mastectomy, with or without reconstruction. Findings suggest that imaging surveillance in this context is unnecessary in clinical practice, at least until further studies demonstrate otherwise. Future studies should consider using the clinically occult cancer detection rate as a more clinically relevant measure in this setting.
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Affiliation(s)
- Daniel Smith
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Setara Sepehr
- School of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Fredrik Strand
- Breast Radiology, Karolinska University Hospital, Solna, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Solna, Sweden
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Cho E, Lee JH, Park EH, Byun KD, Roh MS, Baek HJ, Ryu KH. Silicone-induced lymphadenopathy mimicking recurrence of breast cancer on positron emission tomography-computed tomography, correctly diagnosed on ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:610-613. [PMID: 33782976 DOI: 10.1002/jcu.23010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Silicone-induced lymphadenopathy is a rare complication associated with silicone breast implants. It is usually asymptomatic and found incidentally during imaging. We report a case of silicone lymphadenopathy in a patient who had undergone a mastectomy and breast reconstruction for breast cancer. During follow-up, a positron emission tomography-computed tomography examination revealed lymph nodes that were suspicious for cancer recurrence. However, sonography was able to correctly diagnose silicone-induced lymphadenopathy and exclude cancer metastasis.
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Affiliation(s)
- Eun Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Jin Hwa Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, South Korea
| | - Eun Hwa Park
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Kyung Do Byun
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Mee Sook Roh
- Department of Pathology, Dong-A University College of Medicine, Busan, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
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Al-Khalili R, Alzeer A, Nguyen GK, Crane EP, Song JH, Jeon JL, Nellamattathil M, Makariou EV, Mango VL. Palpable Lumps after Mastectomy: Radiologic-Pathologic Review of Benign and Malignant Masses. Radiographics 2021; 41:967-989. [PMID: 33989071 DOI: 10.1148/rg.2021200161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients who have undergone mastectomy, with or without reconstruction, are not universally screened with mammography or US. Therefore, clinical breast examination by the physician and patient-detected palpable abnormalities are crucial for detecting breast cancer or recurrence. Diagnostic US is the first-line modality for evaluation of postmastectomy palpable masses, with occasional adjunct use of diagnostic mammography for confirming certain benign masses. In the setting of a negative initial imaging evaluation with continued clinical concern, diagnostic MRI may aid in improving sensitivity. Knowledge of the typical multimodality imaging appearances and locations of malignant palpable abnormalities-such as invasive carcinoma recurrence, cancer in residual breast tissue, radiation-induced sarcoma, and metastatic disease-is crucial in diagnosis and treatment of these entities. In addition, familiarity with the range of benign palpable postmastectomy processes-including fat necrosis, fat graft, seroma, granuloma, neuroma, fibrosis, and infection-may help avoid unnecessary biopsies and reassure patients. The authors review common and rare benign and malignant palpable masses in mastectomy patients, describe multimodality diagnostic imaging evaluation of each entity, review radiologic and pathologic correlation, and acquaint the radiologist with management when these findings are encountered. ©RSNA, 2021.
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Affiliation(s)
- Rend Al-Khalili
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Ali Alzeer
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Giang-Kimthi Nguyen
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Erin P Crane
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Judy H Song
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Janice L Jeon
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Michael Nellamattathil
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Erini V Makariou
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Victoria L Mango
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
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Wang Y, Liu D, Wu Z. Ultrasound May Help Detect Chest Wall Recurrence After Mastectomy at an Early Stage. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2339-2349. [PMID: 32436597 DOI: 10.1002/jum.15343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To define ultrasound (US) features that help diagnose local recurrence (LR) and differentiate benign masses from LR chest wall masses after mastectomy in patients with breast cancer. METHODS The US and surgical records of 119 pathologically confirmed chest wall masses in 101 patients were reviewed from 4634 patients with breast cancer who underwent mastectomies. The chest wall masses were divided into 2 groups depending on their longitudinal diameter (LD; ≤10 and > 10 mm). The US features of the subgroups, depending on their nature (benign and LR), were analyzed and compared. RESULTS Among 119 masses, 58 (48.74%) were benign masses, and 61 (51.26%) were LR masses. For LR, the mean area under the curve ± SD, sensitivity, and specificity of US were 0.849 ± 0.033, 85.25%, and 84.48% (P < .001), respectively. Among the US characteristics, vascularity, an irregular shape, and a location in deep layers were the top 3 factors related to LR (odds ratios, 4.0, 2.6, and 2.2). To diagnose LR by US, judging the anatomic layer of the locations of masses with an LD of 10 mm or less and the presence of vascularity in masses with an LD of greater than 10 mm were helpful. CONCLUSIONS Ultrasound is a relatively accurate and objective method to differentiate LR from a benign mass after mastectomy with follow-up. Judging the anatomic layer of the mass location with US likely increases the accuracy of LR diagnosis at an early stage.
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Affiliation(s)
- Ying Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Danru Liu
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhifeng Wu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Bromley L, Xu J, Loh SW, Chew G, Lau E, Yeo B. Breast ultrasound in breast cancer surveillance; incremental cancers found at what cost? Breast 2020; 54:272-277. [PMID: 33242753 PMCID: PMC7695899 DOI: 10.1016/j.breast.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose To determine the diagnostic parameters of breast ultrasound (US) in the setting of routine radiological surveillance after a diagnosis of breast cancer and evaluate costs of the inclusion of breast US as well as any survival benefit of US detected cases of recurrence in surveillance. Methods 622 patients underwent breast cancer surgery and follow up at Austin Health from July 2009 to December 2015. Retrospective data analysis was performed to determine; diagnostic parameters, financial costs of US and survival outcomes of US detected cases of recurrence. Results Patients underwent 1–9 years of breast cancer surveillance, with a median of 4.24 years. 390 (62.7%) patients underwent additional breast US surveillance to mammography. 232 (38.3%) fit criteria for use of additional breast US. 199 abnormal imaging episodes occurred, leading to 16 screen detected-cases of locoregional recurrence. US alone generated 107 abnormal images and found 9 cancers. US had a sensitivity of 44.1%, specificity of 95.2% and positive predictive value of 11.7% in comparison to mammography; 20.6%, 97.4% and 9.9% respectively. US had a biopsy rate of 4.0% and lead to an incremental cancer detection rate of 0.38%. The cost of incremental cancer found was $31,463.72 AUD. Survival outcomes based on method of detection of recurrence were insignificant (p value = 0.71). Conclusions Breast US has a sensitivity of 44.1% and detected seven recurrences that were mammographically occult. Breast US has a similar PPV to mammography in surveillance. Breast US generated considerable biopsy rates and costs. Survival analysis was not able to detect any benefit of US detected cases of recurrence. Breast ultrasound in asymptomatic surveillance after breast cancer surgery was found to have a sensitivity of 44.1%. Breast ultrasound detected 7 recurrences in 390 patients who did not meet criteria for adjunct breast US and had normal mammography Breast ultrasound generated 26 additional biopsies per 1000 US compared to mammography in surveillance, creating considerablecosts. Cancer detection by breast US alone did not lead to statistically significant survival benefit over mammography.
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Affiliation(s)
- Luke Bromley
- Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia; the University of Melbourne, Parkville, 3010, VIC, Australia.
| | - Jennifer Xu
- the University of Melbourne, Parkville, 3010, VIC, Australia
| | - Su-Wen Loh
- Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Grace Chew
- Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Eddie Lau
- Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Belinda Yeo
- Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia; Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, 3084, VIC, Australia; the University of Melbourne, Parkville, 3010, VIC, Australia
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ACR Appropriateness Criteria® Imaging After Mastectomy and Breast Reconstruction. J Am Coll Radiol 2020; 17:S403-S414. [PMID: 33153553 DOI: 10.1016/j.jacr.2020.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022]
Abstract
Mastectomy may be performed to treat breast cancer or as a prophylactic approach in women with a high risk of developing breast cancer. In addition, mastectomies may be performed with or without reconstruction. Reconstruction approaches differ and may be autologous, involving a transfer of tissue (skin, subcutaneous fat, and muscle) from other parts of the body to the chest wall. Reconstruction may also involve implants. Implant reconstruction may occur as a single procedure or as multistep procedures with initial use of an adjustable tissue expander allowing the mastectomy tissues to be stretched without compromising blood supply. Ultimately, a full-volume implant will be placed. Reconstructions with a combination of autologous and implant reconstruction may also be performed. Other techniques such as autologous fat grafting may be used to refine both implant and flap-based reconstruction. This review of imaging in the setting of mastectomy with or without reconstruction summarizes the literature and makes recommendations based on available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Helal M, Mansour S, Ahmed H, Abdel Ghany A, Kamel O, Elkholy N. The role of contrast-enhanced spectral mammography in the evaluation of the postoperative breast cancer. Clin Radiol 2019; 74:771-781. [DOI: 10.1016/j.crad.2019.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
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Kim SJ, Kim JY. An Unusual Cutaneous Recurrence of Carcinoma in the Mastectomy Bed and Its Imaging Features: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:800-805. [PMID: 31171763 PMCID: PMC6570996 DOI: 10.12659/ajcr.916609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 44 Final Diagnosis: Cutaneous recurrence of carcinoma in the mastectomy bed Symptoms: Palpable lump Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ji Yeon Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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You JK, Song MK, Kim MJ, Kim EK, Moon HJ, Youk JH, Yoon JH, Park VY, Park S, Kim SI, Park BW. Can Biannual Ultrasound Surveillance Detect Smaller Second Cancers or Detect Cancers Earlier in Patients with Breast Cancer History? ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1355-1363. [PMID: 29653773 DOI: 10.1016/j.ultrasmedbio.2018.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/08/2018] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
The aim of the work described here was to evaluate whether surveillance with biannual ultrasound (US) plus annual mammography (biannual group) for women with a history of breast cancer surgery results in earlier detection or in the detection of smaller second cancers than annual US plus mammography (annual group). Additionally, we compared the prevalence of distant metastases or palpable second cancers between the biannual and annual groups. The institutional review board of our institution approved this retrospective study, and patient consent was waived. Between January 2011 and December 2012, we retrospectively reviewed the clinical and imaging follow-up of 3023 patients with mammographic and US surveillance after breast cancer surgery to assess second cancers detected by local surveillance (locoregional recurrence, contralateral breast cancer or distant metastasis). The biannual and annual groups were divided with respect to the mean surveillance interval and compared with respect to clinicopathologic findings. Multivariable logistic regression with propensity score methods was used to examine the effect of the type of surveillance on outcomes. As for the size of the second cancer, no difference was seen between the biannual and annual groups (12.8 ± 6.6 mm vs. 14.1 ± 7.1 mm, p = 0.461); neither was there a significant difference between the groups in the presence of symptoms at the time of diagnosis of the second cancer (17.0% [8/47] vs. 10% [2/20], p = 0.711). Regardless of detection by local surveillance, the prevalence of distant metastases did not differ between the two groups (1.1% [27/2370] vs. 1.0% [7/653], p = 0.88) on univariate or multivariate analysis. The results of our retrospective study indicate that second cancers detected by biannual US surveillance in patients with a history of breast cancer surgery are not smaller and do not occur earlier than those detected by annual US surveillance. However, a randomized controlled study is required to verify these results before they can be generalized to clinical practice.
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Affiliation(s)
- Jai Kyung You
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea; Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea
| | - Mi Kyung Song
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Seho Park
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Seung Il Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Byeong-Woo Park
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
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Houssami N, Cho N. Screening women with a personal history of breast cancer: overview of the evidence on breast imaging surveillance. Ultrasonography 2018; 37:277-287. [PMID: 30056638 PMCID: PMC6177686 DOI: 10.14366/usg.18017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/07/2018] [Indexed: 12/25/2022] Open
Abstract
This work reviews the evidence on breast imaging for screening (surveillance) in women with a history of breast cancer (BC). Early detection of second BCs in these women improves their prognosis based on studies using mammography (usually with clinical examinations) for surveillance. Cohort studies have estimated that mammography surveillance has moderate sensitivity (65.4%) and good specificity (98.3%), and have shown that these women are at a higher risk of interval BC than age- and breast density-matched women without a history of BC. Studies of adjunct imaging (ultrasound, magnetic resonance imaging) for surveillance that have reported detection and accuracy measures have generally shown that adjunct imaging detected more second BCs than mammography and added substantially to the amount of false-positive results; however, little evidence exists regarding screening efficacy of adjunct imaging as part of routine surveillance.
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Affiliation(s)
- Nehmat Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Park VY, Kim EK, Kim MJ, Moon HJ, Yoon JH. Breast magnetic resonance imaging for surveillance of women with a personal history of breast cancer: outcomes stratified by interval between definitive surgery and surveillance MR imaging. BMC Cancer 2018; 18:91. [PMID: 29357842 PMCID: PMC5778805 DOI: 10.1186/s12885-018-3998-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/16/2018] [Indexed: 11/17/2022] Open
Abstract
Background Women with a personal history of breast cancer are at increased risk of future breast cancer events, and may benefit from supplemental screening methods that could enhance early detection of subclinical disease. However, current literature on breast magnetic resonance (MR) imaging surveillance is limited. We investigated outcomes of surveillance breast magnetic resonance (MR) imaging in women with a personal history of breast cancer. Methods We reviewed 1053 consecutive breast MR examinations that were performed for surveillance in 1044 women (median age, 53 years; range, 20–85 years) previously treated for breast cancer between August 2014 and February 2016. All patients had previously received supplemental surveillance with ultrasound. Cancer detection rate (CDR), abnormal interpretation rate and characteristics of MR-detected cancers were assessed, including extramammary cancers. We also calculated the PPV1, PPV3, sensitivity and specificity for MR-detected intramammary lesions. Performance statistics were stratified by interval following initial surgery. Results The CDR for MR-detected cancers was 6.7 per 1000 examinations (7 of 1053) and was 3.8 per 1000 examinations (4 of 1053) for intramammary cancers. The overall abnormal interpretation rate was 8.0%, and the abnormal interpretation rate for intramammary lesions was 7.2%. The PPV1, PPV3, sensitivity and specificity for intramammary lesions was 5.3% (4 of 76), 15.8% (3 of 19), 75.0% (3 of 4) and 98.3% (1031 of 1049), respectively. For MR examinations performed ≤36 months after surgery, the overall CDR was 1.4 per 1000 examinations. For MR examinations performed > 36 months after surgery, the overall CDR was 17.4 per 1000 examinations. Conclusions Surveillance breast MR imaging may be considered in women with a history of breast cancer, considering the low abnormal interpretation rate and its high specificity. However, the cancer detection rate was low and implementation may be more effective after more than 3 years after surgery.
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Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
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Tsai WC, Wei HK, Hung CF, Kwang-Jane Lin C, Hung-Chun Cheng S, Chen CM, Wang YA. Better Overall Survival for Breast Cancer Patients by Adding Breast Ultrasound to Follow-Up Examinations for Early Detection of Locoregional Recurrence-A Survival Impact Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2058-2064. [PMID: 27184247 DOI: 10.1016/j.ultrasmedbio.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/24/2016] [Accepted: 04/06/2016] [Indexed: 06/05/2023]
Abstract
We retrospectively reviewed patient records to evaluate the effectiveness of our 15 y of ultrasound (US) surveillance of recurrent breast disease in comparison with mammography (MM) and clinical examination. From 4796 stage 0-III breast cancer patients who had received surgical treatment, we identified locoregional recurrence (LRR) in 161 patients. The mean age of the 161 patients was 48 y (27-82 y), and the mean follow-up interval was 77.2 mo (11-167 mo). The methods of LRR detection, sites of LRR and overall survival (OS) were examined. Multivariate Cox survival analysis showed significantly better survival in groups detected by US (hazard ratio = 0.6, p = 0.042). The 10-y LRR OS by detection types for US (n = 69), clinical examination (n = 78) and MM (n = 8) were 58.5%, 33.1% and 100%, respectively (p = 0.0004). US was seen with better OS associated with the effective early detection of non-palpable LRR breast cancer, which is mostly not detectable on MM.
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Affiliation(s)
- Wan-Chen Tsai
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Hung-Kuang Wei
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chen-Fang Hung
- Department of Clinical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | | | - Skye Hung-Chun Cheng
- Department of Clinical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chii-Ming Chen
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yong Alison Wang
- Internal Medicine Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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Tardivon A. Suivi radiologique après cancer du sein : adaptation au risque résiduel ? IMAGERIE DE LA FEMME 2016. [DOI: 10.1016/j.femme.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yoon JH, Kim MJ, Kim EK, Moon HJ. Imaging surveillance of patients with breast cancer after primary treatment: current recommendations. Korean J Radiol 2015; 16:219-28. [PMID: 25741186 PMCID: PMC4347260 DOI: 10.3348/kjr.2015.16.2.219] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 11/24/2014] [Indexed: 11/29/2022] Open
Abstract
Women who have been treated for breast cancer are at risk for second breast cancers, such as ipsilateral recurrence or contralateral metachronous breast cancer. As the number of breast cancer survivors increases, interest in patient management and surveillance after treatment has also increased. However, post-treatment surveillance programs for patients with breast cancer have not been firmly established. In this review, we focus on the imaging modalities that have been used in post-treatment surveillance for patients with breast cancer, such as mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography, the effectiveness of each modality for detecting recurrence, and how they can be applied to manage patients.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
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Diagnostic value of virtual touch tissue quantification for breast lesions with different size. BIOMED RESEARCH INTERNATIONAL 2014; 2014:142504. [PMID: 24800205 PMCID: PMC3996890 DOI: 10.1155/2014/142504] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/06/2014] [Accepted: 02/24/2014] [Indexed: 11/21/2022]
Abstract
Purpose. To evaluate diagnostic value of the virtual touch tissue quantification (VTTQ) for breast lesions with different sizes. Materials and Methods. Patients with 206 breast lesions were categorized into three groups according to lesion size (<10 mm, 10–20 mm, and >20 mm). Breast lesions were examined by conventional ultrasound and VTTQ, and shear wave velocity (SWV) of each lesion and adjacent normal breast tissue were measured. Diagnoses were confirmed by pathological examination after surgery. The receiver-operating characteristic curve (ROC) analyses were performed to evaluate the diagnostic value of SWV, and the area under curves (AUC) was compared among groups. Results. SWV of malignant lesions was much higher than that of benign lesions, whereas the difference was not obvious for lesions <10 mm (P = 0.15). There was statistical significant difference of AUC between lesions <10 mm and 10–20 mm (P < 0.05), as well as lesions <10 mm and >20 mm (P < 0.05). The sensitivity of lesions <10 mm was 33.33%, which was relatively low compared to other groups. Conclusion. According to our results, VTTQ is a promising method for breast lesions >10 mm, and further studies were warranted to improve sensitivity of VTTQ for breast lesions <10 mm.
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Behnke NK, Crosby SN, Stutz CM, Holt GE. Periscapular amputation as treatment for brachial plexopathy secondary to recurrent breast carcinoma: a case series and review of the literature. Eur J Surg Oncol 2013; 39:1325-31. [PMID: 24176674 DOI: 10.1016/j.ejso.2013.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 12/28/2022] Open
Abstract
AIMS Recurrent breast carcinoma with brachial plexus involvement is often misinterpreted as a radiation- or chemotherapy-induced brachial plexopathy. We review a case series of 4 patients at our institution within a 1-year period, and describe their diagnostic workup and treatment with a palliative periscapular amputation. Our aim is to describe this entity, indications and benefits of this procedure, when required for progressive disease, with the goal of raising a collective index of suspicion to aid in earlier diagnosis. METHODS Four patients with recurrent axillary breast cancer and symptoms consistent with a brachial plexopathy were prospectively collected over a 1-year period. A Pubmed search was conducted; pertinent articles were reviewed and reported. RESULTS Patients presented with intractable pain and flaccid paralysis of the ipsilateral limb. All had been previously treated with surgical resection, axillary lymph node dissection, chemotherapy, and radiation therapy. Average time from breast surgery to presentation was 78.75 months (range 11-216 months.) Workup included MRI and biopsy to confirm recurrence. Periscapular amputation was performed for each patient, all of who experienced subjective pain relief postoperatively. Three of the 4 patients are still living; one patient died of disease. CONCLUSION Breast cancer survivors presenting with a brachial plexopathy should raise suspicion for recurrent disease. Close evaluation with MRI is the best first step in diagnosis. Although periscapular amputation is an aggressive surgical treatment, it is an acceptable option when disease has progressed to neurovascular involvement and a functionless limb.
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Affiliation(s)
- N K Behnke
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, 1215 21st Ave South, Nashville, TN 37232, USA
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Kim H, Kang BJ, Kim SH, Kim HS, Cha ES. What we should know in mammography after reduction mammoplasty and mastopexy? Breast Cancer 2013; 22:391-8. [PMID: 24000038 DOI: 10.1007/s12282-013-0494-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/22/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reduction mammoplasty and mastopexy (breast lift surgery) are becoming increasingly common procedures. Knowledge of characteristic mammographic findings and imaging findings of breast cancer are important to interpret mammography in this population. METHODS Patients undergoing a mammography examination between March 2006 and March 2012 were consecutively included. Seventy mammography examinations in 39 patients after reduction mammoplasty and 22 mammography examinations in 19 patients after mastopexy were reviewed and analyzed retrospectively. We compared the frequency of each characteristic mammographic finding between reduction mammoplasty and mastopexy. We also analyzed imaging findings of breast cancer in this population. RESULTS The most frequent mammographic finding of the reduction mammoplasty was nipple elevation (84.3 %). Other findings included retraction of the lower breast (80 %), thickening of the skin (78.6 %), downward shifting of the glandular tissue (47.1 %), retroareolar fibrotic band (42.9 %), and areolar skin calcification or lipid cyst (35.7 %). The most frequent mammographic finding of mastopexy was thickening of the skin (72.7 %). Other mastopexy findings included elevation of nipple (68.2 %), areolar skin calcification or lipid cyst (36.4 %), retraction of lower position (31.8 %), and retroareolar fibrotic band (31.8 %). Downward shifting of glandular tissue and retraction of the lower portion have statistically lower frequency in mastopexy cases (P < 0.05). Two breast cancers were diagnosed in reduction mammoplasty cases. One was missed and one was detected but difficult to diagnose using mammography. CONCLUSION Although mammography alone is not sufficient for breast screening after reduction mammoplasty, it may be possible to use mammography for postoperative follow-up after mastopexy only. So, operators should recognize that after reduction mammoplasty it will be hard to detect early breast cancer.
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Affiliation(s)
- Hanna Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, 137-040, Korea
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