Imaging Surveillance of the Reconstructed Breast in a Subset of Patients May Aid in Early Detection of Breast Cancer Recurrence

Abstract

Objectives: The purpose of this study is to determine the biological markers more frequently associated with recurrence in the reconstructed breast, to evaluate the detection method, and to correlate recurrent breast cancers with the detection method.

Material and methods: An institutional review board-approved retrospective study was conducted at a single institution on 131 patients treated with mastectomy for primary breast cancer followed by breast reconstruction between 2005 and 2012. Imaging features were correlated with clinical and pathologic findings.

Results: Of the 131 patients who met our inclusion criteria, 40 patients presented with breast cancer recurrence. The most common histopathologic type of primary breast cancer was invasive ductal carcinoma in 82.5% (33/40) of patients. Triple-negative breast cancer was the most common biological marker with 42.1% (16/38) of cases. Clinically, 70% (28/40) of the recurrences presented as palpable abnormalities. Of nine patients who underwent mammography, a mass was seen in eight patients. Of the 35 patients who underwent ultrasound evaluation, an irregular mass was found in 48.6% (17/35) of patients. Nine patients with recurrent breast cancer underwent breast MRI, and MRI showed an irregular enhancing mass in four patients, an oval mass in four patients, and skin and trabecular thickening in one patient. About 55% of patients with recurrent breast cancer were found to have distant metastases.

Conclusion: Patients at higher risk for locoregional recurrence may benefit from imaging surveillance in order to detect early local recurrences.

Keywords: Biological markers; Breast cancer recurrence; Deep recurrences; Reconstructive surgery.

Figure 1:

A 70-year-old woman with a history of left breast IDC (ER−, PR−, HER2−), status post mastectomy with TRAM reconstruction. She presented with a palpable abnormality in the upper outer left breast. (a and b) CC and MLO mammograms show an oval hyperdense mass with circumscribed margins correlating with the palpable abnormality (white arrows). (c) Longitudinal gray scale ultrasound shows a superficial oval bilobed hypoechoic mass (arrows) correlating with the palpable abnormality. Ultrasound-guided core biopsy showed recurrent IDC.

Figure 2:

A 57-year-old woman with a history of myoepithelial cancer (ER−, PR−, HER2−) who underwent mastectomy and reconstruction with deep inferior epigastric artery perforator (DIEP) flap. She presented with thickening and pain in the right reconstructed breast. (a) Axial T1-weighted MRI with contrast shows a bilobed rim enhancing mass involving the pectoralis major muscle and the chest wall muscles (arrows). (b) Sagittal T2-weighted MRI shows that the mass is hypointense (arrow) and associated with marked peritumoral edema. (c) Longitudinal gray-scale ultrasound shows that the mass is oval and hypoechoic (arrows). (d) Power Doppler ultrasound shows internal vascularity in the mass. Ultrasound-guided core biopsy showed a recurrent myoepithelial cancer.