I wanted to share this article (1st reference below) with you. I feel it is important as we continue to improve the treatment of breast cancer. Our surgical treatments can change the surveillance.
The purpose of this review was to evaluate long-term postoperative cancer surveillance techniques in a group of patients with breast cancer who underwent partial breast reconstruction using reduction techniques. We were interested in determining whether mammographic screening remained a sensitive tool following oncoplastic reduction and whether the observed changes and diagnostic testing differed in this patient group.We hypothesized that patients undergoing the reduction techniques might have additional qualitative mammographic changes compared with patients undergoing breast conservation therapy alone, with longer time to stability.We further hypothesized that the mammographic changes and clinical concerns in the oncoplastic group would result in more diagnostic testing (mammograms, ultrasound, and magnetic resonance imaging) and in the need for additional tissue sampling events.
Tumor recurrence is typically found at the lumpectomy bed (true recurrence), adjacent to it (marginal miss), or elsewhere in the treated breast. The greatest emphasis on surveillance is in the first 5 years, as this is when the risk of recurrence is the highest; however, the risk does persist.
The main objectives are to (1) exclude residual disease, (2) rule out recurrence, (3) establish a new baseline, and (4) evaluate for metachronous disease, while minimizing misinterpretation.Mammography following breast conservation therapy has been shown to be sensitive in about 55 to 68 percent of breast conservation patients. Mendelson followed the mammographic changes over time following breast conservation, with the most frequent findings being skin thickening and breast edema in almost 100 percent of patients.Other findings at 6 months after treatment include scarring and fibrosis (50 percent), fluid collections/seromas (40 percent), and dystrophic calcifications (10 percent). Skin thickening, edema, and seromas did tend to resolve with time and likely represent the changes associated with radiation dermatitis. These conditions will often peak at about 6 months after radiation therapy and resolve over 2 to 3 years in most patients.
Since the 95 percent confidence interval for stability in the oncoplastic group was 20.5 to 30.7 months, we believe that, based on these data, biannual mammographic screening should be extended until the third postoperative year in patients who undergo partial breast reconstruction to confirm stability, and that it should be performed on an annual basis thereafter.Accurate interpretation of postoperative images requires familiarity with these temporal changes following partial breast reconstruction. Establishing a new baseline is important and will avoid unnecessary biopsies, because many of the posttreatment mammographic findings can mimic radiographic signs of malignancy.