The role of computed tomography in the investigation of recurrent axillary disease in patients with carcinoma of the breast

Management of local recurrence of breast cancer

This article reviews the management of isolated recurrences after primary treatment of breast cancer. These recurrences may occur within the breast after breast-conserving surgery, on the chest wall after mastectomy, or in the axilla. While often a marker of concurrent or future metastatic disease, local management with curative intent is advocated if the recurrence is isolated at presentation. Systemic therapy at this time (readjuvant) may well have benefit and should be more thoroughly investigated. Changes in breast cancer management, including sentinel lymph node biopsy, neoadjuvant chemotherapy, hormonal therapy and partial breast irradiation, may change the implications and management of isolated local breast, chest wall and axillary recurrences.

High resolution CT mammography of surgical biopsy specimens

PURPOSE

Our goal was to assess the performance of high resolution CT on breast biopsy specimens before considering the reevaluation of refined CT techniques in patients with breast abnormalities.

METHOD

High resolution CT was done in 44 surgical biopsy specimens following conventional X-ray specimen mammography. The specimens comprised 38 palpable and nonpalpable soft tissue abnormalities with mean size of 19 mm and 6 specimens with clustered microcalcifications only. There were 21 carcinomas, 10 fibroadenomas, and 13 other benign conditions. Evaluation of CT and conventional images was done separately, and a feature-grading list was used to compare the two modalities.

RESULTS

In fatty specimens, grading of morphologic features of masses and the confidence to detect a soft tissue abnormality were equal with both techniques. CT significantly improved the confidence to detect a mass in 17 specimens with dense tissue: On a scale of 0-10, the mean score for detection was 3.8 with radiography and 5.8 with CT (p<0.008). For clustered microcalcifications, X-ray was superior to CT. The mean CT attenuation of 18 malignant masses (82 HU) was significantly lower than the mean attenuation of 10 fibroadenomas (131 HU; p = 0.003). CT scans of the American College of Radiology test phantom met the requirements for X-ray accreditation.

CONCLUSION

For soft tissue abnormalities, CT specimen mammography performed equally as or better than specimen radiography. These in vitro results suggest potential advantages for increased sensitivity and specificity with CT and justify further investigations.