1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Noreña-Rengifo BD, Sanín-Ramírez MP, Adrada BE, Luengas AB, Martínez de Vega V, Guirguis MS, Saldarriaga-Uribe C. MRI for Evaluation of Complications of Breast Augmentation. Radiographics 2022; 42:929-946. [PMID: 35559662 DOI: 10.1148/rg.210096] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Breast augmentation is one of the most common aesthetic procedures performed in the United States. Several techniques of breast augmentation have been developed, including the implantation of breast prostheses and the injection of autologous fat and other materials. The most common method of breast augmentation is to implant a prosthesis. There are different types of breast implants that vary in shape, composition, and the number of lumina. The rupture of breast implants is the leading cause of implant removal. The rupture rate increases substantially with the increasing age of the implant. Most implant ruptures are asymptomatic. Implant complications can be grouped into two categories: local complications in the breast and adjacent soft tissue, and systemic complications associated with rheumatologic or neurologic symptoms. The onset of local complications may be early (infection and periprosthetic collections including seromas, hematomas, or abscesses) or late (capsular contraction, implant rupture, gel bleed, or breast implant-associated anaplastic large cell lymphoma). Although mammography is the imaging modality for breast cancer screening, noncontrast breast MRI is the imaging modality of choice for evaluation of the integrity of breast implants and the complications of breast augmentation, for equivocal findings at conventional imaging, and as a supplement to mammography in patients with free injectable materials. The fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) provides a systematic outline for MRI evaluation of patients with breast implants. Silicone- and water-selective sequences provide useful supplemental information to confirm intracapsular and extracapsular rupture. Breast MRI for evaluation of implant integrity does not require intravenous contrast material. The use of MRI contrast material in patients with breast augmentation is indicated when infection or malignancy is suspected. Radiologists should have a thorough understanding of the different techniques for breast augmentation, normal imaging features, and complications specific to breast augmentation. An invited commentary by Ojeda-Fournier is available online. ©RSNA, 2022.
Collapse
Affiliation(s)
- Brian D Noreña-Rengifo
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Maria Paulina Sanín-Ramírez
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Beatriz E Adrada
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Ana Beatriz Luengas
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Vicente Martínez de Vega
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Mary S Guirguis
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Cristina Saldarriaga-Uribe
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| |
Collapse
|
3
|
Corines MJ, Krystel-Whittemore M, Murray M, Mango V. Uncommon Tumors and Uncommon Presentations of Cancer in the Breast. CURRENT BREAST CANCER REPORTS 2021; 13:331-346. [PMID: 36589040 PMCID: PMC9798716 DOI: 10.1007/s12609-021-00435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose of review The purpose is to present a case series of rare diagnoses and unusual presentations of breast lesions with radiologic-pathologic correlation from a major cancer center, and to review the recent literature on each entity with a focus on radiology-pathology concordance. We present our findings and experience from cases of metastatic small cell lung carcinoma to the breast, IgG-4 related breast disease, breast implant associated anaplastic large cell lymphoma, granular cell tumor, pleomorphic sarcoma, adenomyoepithelioma, post-radiation angiosarcoma, and breast carcinoma after risk-reducing total mastectomy. Recent findings It is essential for physicians to have knowledge of rare breast diagnoses and unusual breast disease presentations to formulate a complete differential diagnosis, recognize radiological-pathological concordance of these entities and provide appropriate patient care. Summary Current literature on these rare described entities exists mainly as case reports, case series and small-scale studies. By sharing our findings, we hope to educate trainees in radiology, pathology and other fields across the continuum of care in radiologic-pathologic correlation, while also augmenting the existing literature on these rare entities.
Collapse
Affiliation(s)
- Marina J. Corines
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 300 E 66th Street, New York, NY 10065,Corresponding author: Marina J. Corines, MD, 1275 York Ave, Department of Radiology, New York, New York, 10065, Telephone: (914) 319-6970,
| | | | - Melissa Murray
- Memorial Sloan Kettering Cancer Center, Department of Pathology, 1275 York Avenue, New York, NY 10065
| | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 300 E 66th Street, New York, NY 10065
| |
Collapse
|
4
|
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: 2] [Impact Index Per Article: 0.7] [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.
Collapse
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.)
| |
Collapse
|
5
|
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: 2] [Impact Index Per Article: 0.5] [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.
Collapse
|
6
|
Pryce C, Owen W. Palpable Masses after Mastectomy: Differentiating Benign Postoperative Findings from Recurrent Disease. JOURNAL OF BREAST IMAGING 2020; 2:501-510. [PMID: 38424907 DOI: 10.1093/jbi/wbaa048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Indexed: 03/02/2024]
Abstract
Due to postoperative changes, imaging evaluation of patients with palpable masses after mastectomy can be challenging. There is considerable overlap between the imaging characteristics of recurrent disease and benign postoperative findings in patients with or without breast reconstruction. US is the initial modality of choice for evaluating palpable masses in most patients after mastectomy. In cases where US findings are not classic, however, other modalities are useful in problem solving, including both mammography and MRI. It is imperative that radiologists are educated about benign and malignant imaging characteristics, further workup considerations, and appropriate management. In cases where findings are not characteristic across multiple imaging modalities, biopsy may be warranted.
Collapse
Affiliation(s)
- Cherah Pryce
- University of Kentucky, Department of Radiology, Lexington, KY
| | - Wendi Owen
- University of Kentucky, Department of Radiology, Lexington, KY
| |
Collapse
|