2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

SURVEILLANCE FOLLOWING BREAST CANCER DIAGNOSIS
Fig. 5. Palpable mass near scar; US shows typical features of fat
necrosis.
Abbreviation: US, ultrasound.
TRAM flaps in our practice but may vary according to the
distributions of types of reconstruction in your group. Mammography
often demonstrates early dystrophic microcalcifications,
which can simulate an aggressive recurrent DCIS
(Fig. 4 and Fig. 5).
Bilateral Mastectomy with Reconstruction
Little is known about the utility of MRI as a diagnostic or
surveillance tool after bilateral mastectomy with reconstruction.
The current role of MRI in treating patients who have
had a mastectomy is primarily as a diagnostic tool when
clinical findings need clarification. Most recurrences adjacent
to an implant are clinically palpable, and there is little
evidence to support the use of MRI in asymptomatic postmastectomy
with reconstruction patients. Patients who
have undergone reconstruction with TRAM or deep inferior
epigastric perforator flaps can be evaluated with MRI;
however, routine surveillance is not common practice, as the
risk of nonpalpable recurrence is extremely low. 30 MRI has
been found useful in differentiating benign from malignant
findings in patients with palpable abnormalities or pain
after TRAM reconstruction (Fig. 6). 30
Possible Developing Methods for
Recurrence Detection
To detect additional tumors or metastatic disease at an
early stage, advanced imaging techniques, including diagnostic
mammographic images, focused breast US, breast
Authors’ Disclosures of Potential Conflicts of Interest
Author
Chris I. Flowers*
Blaise P. Mooney*
Jennifer S. Drukteinis*
*No relevant relationships to disclose.
Employment or
Leadership
Positions
Consultant or
Advisory Role
1. Voogd AC, van Tienhoven G, Peterse HL, et al. Local recurrence after
breast conservation therapy for early stage breast carcinoma: detection,
treatment, and outcome in 266 patients. Cancer. 1999;85:437-446.
2. Hietanen P, Miettinen M, Makinen J. Survival after first recurrence in
breast cancer. Eur J Cancer Clin Oncol. 1986;22:913-919.
MRI, and positron emission tomography imaging is often
required. Breast-specific gamma imaging, PEM, and molecular
breast imaging may have a problem-solving role, especially
in the dense breast or where there are complications
from ruptured silicone implants. Radiologists who have
completed advanced training in breast cancer detection
should interpret these imaging techniques. Imaging should
be coupled with clinical exams by specialty-trained clinicians
familiar with signs and symptoms of recurrence and
should occur at set time intervals. The downside of these
newer techniques is the radiation dose from the radioisotopes
currently used, although new techniques are focused
on reducing the radiation dose.
Advanced reconstruction and radiation techniques can be
difficult to interpret unless communication between members
of the health care team is timely and accurate, and
the radiologist is familiar with expected appearances. To
achieve the goal of recurrence detection in the early stages,
before it is clinically evident, radiologists and clinicians
must be familiar with the behavior of subtypes of breast
cancer and different surgical/medical/oncoplastic approaches
to their treatment.
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REFERENCES
Fig. 6. Vague nodularity on physical exam. US of nodularity
showed no correlation. MRI demonstrates obvious local recurrence
and metastases.
Abbreviations: US, ultrasound; MRI, magnetic resonance imaging.
Research
Funding
Expert
Testimony
Other
Remuneration
3. Nomura Y, Tsutsui S, Murakami S, et al. Prognostic impact of second
cancer on the survival of early breast cancer patients. Int J Oncol. 1999;14:
1103-1109.
4. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a
randomized trial comparing total mastectomy, lumpectomy, and lumpectomy
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