Abstract
BackgroundTo evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US).MethodsThe postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated.ResultsA total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7–2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler.ConclusionAB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.
Highlights
To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US)
In a retrospective search of our medical database between August 2017 and June 2020, we identified 329 patients with stage 0 to III breast cancer who underwent BCS and immediate volume replacement with the crosslinked human ADM (MegaDerm; L&C BIO, Seongnam, Korea) derived from donated human skin in the USA tissue banks following the guidelines of the American Association of Tissue Banks and the US Food and Drug Administration
Because we aimed to evaluate the influence of ADM on ipsilateral LTR, we analyzed imaging studies in the treated breast only
Summary
To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). The goal of BCS is to remove breast cancer completely with an adequate resection margin and without compromising cosmetic outcomes [2, 3]. Achieving both goals may be challenging, and approximately 30% of patients who undergo BCS are known to be unsatisfied with their cosmetic outcome [4, 5]. Large-volume resection during BCS can result in unsatisfactory cosmetic outcomes in women with small- to medium-sized breasts [6,7,8,9]. Oncoplastic surgery is a combination of tumor removal and breast reconstruction and is divided into two broad techniques: volume displacement and volume replacement. In patients with relatively small breasts, the volume replacement technique has shown better cosmetic results than the volume displacement technique [6,7,8,9]
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