Evaluation of Appropriate Short-Term Mammographic Surveillance in Patients Who Undergo Breast-Conserving Surgery (BCS)

Abstract

Mammography is an important surveillance tool for detecting ipsilateral breast tumor recurrence (IBTR) after BCS. Although IBTR is rare in the first 2 years, various organizations have established protocols for postoperative mammographic surveillance. Currently there is no consensus on the optimal interval for imaging evaluation of patients following BCS. We conducted a retrospective review of patients who underwent BCS at Aultman Hospital between 1/06 and 12/08. To be included in the study, patients had to be diagnosed with invasive primary breast carcinoma or ductal carcinoma in situ (DCIS), treated with BCS (with or without postoperative breast radiation), and have had at least one postoperative surveillance mammogram at our Breast Care Center. Our mammographic surveillance protocol for patients undergoing BCS consists of ipsilateral mammograms (affected side) around 6 and 18 months and bilateral mammograms around 12 and 24 months. All mammograms that were Breast Imaging-Reporting and Data System (BIRADS) 0 or 4 were reviewed by a single radiologist (T.B.P.). A total of 375 patients constituted the core group for this study. Each interval mammographic screening (6- and 18-month mammograms) resulted in additional imaging in 3-4 % of patients. There was a very low yield for identifying IBTR: 1/266 (0.4 %) for the 5-10-month postoperative mammogram and 1/286 (0.3 %) for the 16-21-month postoperative mammogram. Based on our data and the low expected yield of IBTR in the first 2 years, annual mammographic surveillance appears adequate following BCS and interval ipsilateral mammograms at 6 and 18 months do not provide additional clinical benefit.