Mammographic features of local recurrence after conservative surgery and radiation therapy: Comparison with that of the primary tumor

WOS: 000246782700006PubMed ID: 17453518Purpose: To compare the mammographic features of recurrent breast cancer with those of the primary tumor and to determine whether certain mammographic features are associated with a higher risk of local recurrence after breast-conserving therapy. Material and Methods: A retrospective review of mammograms of 421 patients who were treated with conservative surgery and radiotherapy revealed 41 recurrent tumors. Mammographic findings, location, and histopathologic characteristics were retrospectively compared between primary and recurrent tumors. Results: Recurrent tumors were similar in mammographic appearance to primary tumors in 27 (66%) cases. Of 27 primary tumors that occurred as masses without calcifications, 19 (70%) recurred as a mass, and of the six isolated calcifications, five (83%) recurred with calcifications. Ten (53%) of the 19 recurrent masses and five (100%) of the five recurrent calcifications had morphologic features that were similar to those of the primary tumor. Ninety-two percent (11/12) of the recurrences containing microcalcifications ( isolated or associated with a mass) had microcalcifications in their primary tumor. Of 27 masses that recurred, the morphology of the primary tumor was obscured in 13 (48%), ill defined in 10 (37%), and spiculated in four (15%) of the masses. Seventy-six percent (31/41) of recurrences were within the lumpectomy quadrant. In 25 (61%) cases, the histologic findings from the primary tumor and the recurrence were identical. Conclusion: The majority of recurrent tumors appear to be mammographically similar to primary tumors. Therefore, it is important to review preoperative mammograms during follow-up of these patients. Although the study population is small, it was noted that mass with spiculated contour is associated with a lower risk for local recurrence

Management of microcalcifications developing at the lumpectomy bed after conservative surgery and radiation therapy

WOS: 000245663000018PubMed ID: 17242247OBJECTIVE. The purpose of our study was to determine whether the mammographic features ( morphology and distribution) of new microcalcifications that develop in women treated with lumpectomy and radiation therapy can allow differentiation of benign changes from recurrent neoplasm. MATERIALS AND METHODS. A retrospective review of mammograms of 402 patients who were treated with conservative surgery and radiation therapy between 1987 and 2005 revealed 68 cases of new calcifications ( in 66 patients) with follow-up ( n = 55) or biopsy ( n = 13) results. Analysis included the time between completion of radiation therapy and the appearance of calcifications; location of calcifications relative to the site of the original lesion; the morphology and distribution of calcifications; and changes in number, density, morphology, and rate of change of calcifications. RESULTS. The median rate of development after lumpectomy was 24 months ( range, 6 - 84 months) for benign and 52 months ( range, 20 - 90 months) for malignant calcifications. In 63 cases (93%), the new calcifications developed in the same quadrant as the primary tumor. None of the calcifications initially interpreted as BI-RADS category 2 ( n = 40/68; 59%) and category 3 ( n = 19/68; 28%) represented recurrent disease. Nine (13%) of 68 calcifications were initially classified as BI-RADS category 4 or 5; six (67%) of the nine were malignant and three (33%) were benign at biopsy. CONCLUSION. Newly occurring calcifications in the treated breast are usually benign, and they can be managed conservatively in many cases by using morphology and pattern of distribution as a guide

Tubular carcinoma of the breast: Mammographic, sonographic, clinical and pathologic findings

WOS: 000243799800021PubMed ID: 16987629Purpose: To determine and quantitate the radiological characteristics of tubular carcinoma of the breast, to report clinical and pathologic findings and to define findings at follow-up. Materials and methods: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 32 histopathologically proven pure tubular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up and histopathological results. Results: Fifty-nine percent of the patients (n = 19) presented with a palpable mass. The mammographic findings were a mass in 23 (72%), a mass with microcalcifications in 2 (6%), asymmetric focal density in 1 (3%), architectural distortion in 1 (3%) and negative in 5 (16%) of the 32 patients. Most (96%) masses had spiculated margins. US depicted 30 masses in 29 patients, all of which were hypoechoic, mostly (n = 27, 90%) with posterior acoustic shadowing. The cancer was clinically occult in 41% (n = 13), mammographically occult in 16% (n = 5), and sonographically occult in 6% (n = 2) of the patients. Histologically, the tumor was multifocal in 3% (n = 1) of the patients. Four (13%) patients developed contralateral breast carcinoma at follow-up. Conclusion: Tubular carcinoma has a variety of presentations, but it is mostly seen on mammography as a small spiculated mass, and on sonography as an irregular mass with posterior acoustic shadowing. Although tubular carcinoma is known as a well-differentiated tumor with excellent prognosis, the mammographic follow-up of the contralateral breast is important. (C) 2006 Elsevier Ireland Ltd. All rights reserved