Use of Screening Mammography to Detect Occult Malignancy in Autologous Breast Reconstructions: A 15-year Experience

Abstract

Purpose To examine how often screening mammography depicts clinically occult malignancy in breast reconstruction with autologous myocutaneous flaps (AMFs). Materials and Methods Between January 1, 2000, and July 15, 2015, the authors retrospectively identified 515 women who had undergone mammography of 618 AMFs and who had at least 1 year of clinical follow-up. Of the 618 AMFs, 485 (78.5%) were performed after mastectomy for cancer and 133 (21.5%) were performed after prophylactic mastectomy. Medical records were used to determine the frequency, histopathologic characteristics, presentation, time to recurrence, and detection modality of malignancy. Cancer detection rate (CDR), sensitivity, specificity, positive predictive value, and false-positive biopsy rate were calculated. Results An average of 6.7 screening mammograms (range, 1-16) were obtained over 15.5 years. The frequency of local-regional recurrence (LRR) was 3.9% (20 of 515 women; 95% confidence interval [CI]: 2.2%, 5.6%); all LRRs were invasive, and none were detected in the breast mound after prophylactic mastectomy. Of the 20 women with LRR, 13 (65%) were screened annually before the diagnosis. Seven of those 13 women (54%) had clinically occult LRR, and mammography depicted five. Five of the six clinically evident recurrences (83%) were interval cancers. The median time between reconstruction and first recurrence was 4.4 years (range, 0.8-16.2 years). The CDR per AMF was 1.5 per 1000 screening mammograms (five of 3358; 95% CI: 0.18, 2.8) after mastectomy for cancer and 0 of 1000 examinations (0 of 805 mammograms; 95% CI: 0, 5) after prophylactic mastectomy. Sensitivity, specificity, positive predictive value, and false-positive biopsy rate were 42% (five of 12), 99.4% (4125 of 4151), 16% (five of 31), and 0.6% (26 of 4151), respectively. Conclusion The CDR of screening mammography (1.5 per 1000 screening mammograms) of the AMF after mastectomy for cancer is comparable to that for one native breast of an age-matched woman. Screening mammography adds little value after prophylactic mastectomy. © RSNA, 2018.

Deep Inferior Epigastric Artery Perforator Flap Reconstruction for Breast Burn Deformities

“…The patients should therefore be explicitly counseled that native breast tissue is still present in the reconstructed breast and on the need for future routine breast cancer screening. In a large retrospective review of surveillance mammography in patients with postmastectomy autologous breast reconstruction, Noroozian et al 9 found that continued screening was useful in detecting occult malignancy. MRI was found to be more specific in its ability to detect recurrence before clinical appearance and differentiate between malignant and benign findings.…”

ACR Appropriateness Criteria® Imaging After Mastectomy and Breast Reconstruction

“…The majority of recurrences in the reconstructed breast will be found in the skin and the subcutaneous tissues followed by recurrences deep to the pectoralis muscle [7]. Recurrence rates are reported to be approximately 1% to 2% annually for both mastectomy and mastectomy with reconstruction, and overall recurrence has been reported at between 2% to 15% and has been noted to vary based on the initial cancer type and stage as well as follow-up period of the study [5,[7][8][9][10][11][12][13]. Clinical evaluation has been a mainstay of evaluation of the postmastectomy breast [4], and the appropriate surveillance imaging strategy for patients with a history of mastectomy with or without reconstruction is an evolving topic, with evidence predominantly drawn from small retrospective studies.…”

Follow-Up of Patients with Breast Cancer: Imaging of Local Recurrence and Distant Metastases

“…As long as the breast parenchyma has been completely removed during mastectomy, routine mammography on the affected side will not be neces-sary [16]. However it should be noted that some centers will ignore this advice and perform regular mammography in asymptomatic women after mastectomy with or without reconstruction [17]. If there is suspicion of significant residual breast parenchyma after mastectomy, breast MRI can reliably confirm or exclude residual parenchyma.…”