The role of US and MR imaging in detecting local chest wall tumor recurrence after mastectomy.

PURPOSE To determine the role of clinical examination, ultrasonography (US), and magnetic resonance imaging (MRI) in detecting local tumor recurrence in patients who underwent modified radical mastectomy for breast cancer. MATERIALS AND METHODS The study included 27 patients who were examined between April 1999 and April 2003. US evaluation of the chest wall was performed in all patients. MRI was performed on 10 patients due to suspicious findings in clinical examination, on 3 patients due to US findings, and on 8 patients due to both US and clinical examination findings. Six patients without any suspicious findings underwent MRI for follow-up purposes. The lesions detected with MRI were evaluated according to their morphology, contrast enhancement characteristics and dynamics. The focal lesions that enhanced intensely at the early phase were accepted as suspicious for malignancy. RESULTS Of the 10 cases that underwent biopsy secondary to suspicious lesions for malignancy according to MRI findings, 7 were found to have recurrence. In the remaining 3 patients, recurrence diagnosis was made based on the fact that the lesions regressed in response to chemotherapy. In 17 cases, there were no suspicious findings on MRI for local recurrence. In 2 of these cases, biopsies were performed due to suspicious US findings; however, no malignancies were detected. The sensitivity and specificity of clinical examination in detecting local recurrence was 70% and 35.2%, respectively. These values were 90% and 88.2% for US, and 100% and 100% for MRI. CONCLUSION In patients with mastectomy, US and MRI were more successful in detecting local recurrence than clinical examination. Considering the fact that US is cheaper and more readily available than MRI, it should be part of the routine follow-up in order to detect local recurrence early. MRI will be helpful in cases with suspicious US findings by increasing the specificity of the evaluation as well as determining the actual size and spread of any lesions, which is valuable information for the subsequent management and response to the particular treatment.

[1]  Frederick Kelcz,et al.  Frequency of malignancy in lesions classified as probably benign after dynamic contrast‐enhanced breast MRI examination , 2005, Journal of magnetic resonance imaging : JMRI.

[2]  N. Obuchowski,et al.  Assessment of suspected breast cancer by MRI: a prospective clinical trial using a combined kinetic and morphologic analysis. , 2005, AJR. American journal of roentgenology.

[3]  J. Park,et al.  Normal and abnormal US findings at the mastectomy site. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[4]  C. Kuhl,et al.  Breast MR imaging during or soon after radiation therapy. , 2003, Radiology.

[5]  B. Fornage,et al.  Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. , 2003, Radiology.

[6]  Mathias K. Fehr,et al.  Follow-up of women with breast cancer: comparison between MRI and FDG PET , 2003, European Radiology.

[7]  A. Rieber,et al.  Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease , 2003, European Radiology.

[8]  M. Lell,et al.  Narbe oder Rezidiv? Einsatz der signalverstärkten Doppler-Sonographie im Vergleich zur MRT , 2002 .

[9]  [Scar or recurrence--comparison of MRI and color-coded ultrasound with echo signal amplifiers]. , 2002, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[10]  S. Lakhani,et al.  MR imaging of the skin and nipple of the breast: differentiation between tumour recurrence and post-treatment change , 2001, European Radiology.

[11]  L. Esserman,et al.  MR imaging of the breast in patients with positive margins after lumpectomy: influence of the time interval between lumpectomy and MR imaging. , 2000, AJR. American journal of roentgenology.

[12]  C. Kuhl,et al.  MRI of breast tumors , 2000, European Radiology.

[13]  J. Jager,et al.  Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[14]  D. Fraker,et al.  Breast carcinoma: MR imaging before re-excisional biopsy. , 1997, Radiology.

[15]  T. Rissanen,et al.  Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy , 1997, Acta radiologica.

[16]  J. Willner,et al.  Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis. , 1997, International journal of radiation oncology, biology, physics.

[17]  D. Buckley,et al.  Dynamic contrast enhanced MR , 1996 .

[18]  A Horsman,et al.  Dynamic Contrast-Enhanced Magnetic Resonance Imaging of the Breast Combined with Pharmacokinetic Analysis of Gadolinium-DTPA Uptake in the Diagnosis of Local Recurrence of Early Stage Breast Carcinoma , 1995, Investigative radiology.

[19]  N M Hylton,et al.  Imaging techniques for breast MR imaging. , 1994, Magnetic resonance imaging clinics of North America.

[20]  T. Rissanen,et al.  Breast cancer recurrence after mastectomy: diagnosis with mammography and US. , 1993, Radiology.

[21]  A. Testori,et al.  Locally recurrent breast cancer after 'radical' surgery. , 1992, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[22]  M. Bignardi,et al.  Analysis of prognostic factors in patients with isolated chest wall recurrence of breast cancer , 1987, Cancer.

[23]  W. Gunn.  Cancer: Principles and Practice of Oncology , 1982 .

[24]  B. Fineberg,et al.  Prognostic indicators in patients with isolated local–regional recurrence of breast cancer , 1981, Cancer.

[25]  G. Bonadonna,et al.  Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients , 1978, Cancer.

[26]  G. Fletcher,et al.  Frequency, anatomical distribution and management of local recurrences after definitive therapy for breast cancer , 1966, Cancer.