The detection of recurrent breast cancer in patients with a history of breast cancer surgery: comparison of clinical breast examination, mammography and ultrasonography

Abstract

Breast sonography is commonly used as a follow-up imaging modality for the patients with a history of breast cancer surgery in Korea. It would be necessary to compare its efficacy with other examinations in order to justify inclusion of breast sonography among the routine follow-up imaging modalities. To retrospectively compare the efficacies of clinical breast examination, mammography, and ultrasonography (US), and to evaluate the additional value of US for the detection of recurrent breast cancer in patients with a history of breast cancer surgery. During a 2-year period, we found 74 women with 81 recurrent breast cancers (including locoregional recurrence and contralateral breast cancer) after breast-conserving therapy or mastectomy. The detection abilities of clinical breast examination, mammography, and US were compared for different lesion locations. Fifty-six of the cancers (69.1%) were parenchymal recurrences and 25 (30.9%) were chest wall or axillary lymph node recurrences. Thirty-five were ipsilateral and 46 were contralateral recurrences. For these recurrent lesions, detection rates were 50.6% (41 of 81) by clinical breast examination, 66.1% (39 of 59) by mammography, and 97.5% (79 of 81) by US. Of the 40 nonpalpable recurrent lesions, 19 lesions (23.5%; eight ipsilateral and 11 contralateral) were detected by US alone, two lesions (2.5%; one ipsilateral and one contralateral) were detected by mammography alone, and 19 lesions (four ipsilateral and 15 contralateral) were detected by both US and mammography. US has a crucial role in the detection of recurrent lesions after breast cancer surgery, especially in patients that present with nonpalpable chest wall or axillary lymph node recurrences and mammographic occult parenchymal masses.