3093: Ultrasound in detection of residual breast carcinoma before reexcisional surgery

Abstract

Objectives: To evaluate the value of ultrasound(US) and power Doppler(PD) imaging in the examination of residual breast cancer before re-excision. MRI or mammographic diagnosis of residual disease in patients with positive margins is hampered by postsurgical changes particularly within 1 month after excision.Methods: One hundred thirty patients, status post-lumpectomy and with close or positive margins, underwent US of breast using a 12–13MHz transducer and power map equipment for evaluation of residual disease before re-excision. Time interval between lumpectomy and US ranged 7 to 30 days (mean, 12 days). Postbiopsy mammograms were obtained in 51 of 56 patients with calcium-containing lesions.Results: US depicted 38 (93%) of 41 invasive tumor and 19 (40%) of 48 DCIS. PD US detected one invasive cancer and five DCISs otherwise missed. Postbiopsy mammograms depicted 12 calcified DCIS missed at US. The sensitivity, specificity and positive and negative predictive values of US with PD imaging was 71% (63/89), 90% (46/51), 93% (63/68) and 64% (46/72). In 17 patients (13%), therapy was changed from conserving surgery to mastectomy.Conclusions: US with PD imaging has a high positive predictive value for residual tumor, particularly noncalcified invasive cancers, within 1 month after excision. US can complement mammography in the examination of residual cancer before re-excision. Objectives: To evaluate the value of ultrasound(US) and power Doppler(PD) imaging in the examination of residual breast cancer before re-excision. MRI or mammographic diagnosis of residual disease in patients with positive margins is hampered by postsurgical changes particularly within 1 month after excision. Methods: One hundred thirty patients, status post-lumpectomy and with close or positive margins, underwent US of breast using a 12–13MHz transducer and power map equipment for evaluation of residual disease before re-excision. Time interval between lumpectomy and US ranged 7 to 30 days (mean, 12 days). Postbiopsy mammograms were obtained in 51 of 56 patients with calcium-containing lesions. Results: US depicted 38 (93%) of 41 invasive tumor and 19 (40%) of 48 DCIS. PD US detected one invasive cancer and five DCISs otherwise missed. Postbiopsy mammograms depicted 12 calcified DCIS missed at US. The sensitivity, specificity and positive and negative predictive values of US with PD imaging was 71% (63/89), 90% (46/51), 93% (63/68) and 64% (46/72). In 17 patients (13%), therapy was changed from conserving surgery to mastectomy. Conclusions: US with PD imaging has a high positive predictive value for residual tumor, particularly noncalcified invasive cancers, within 1 month after excision. US can complement mammography in the examination of residual cancer before re-excision.