Abstract
Purpose of Review
To describe the difference between recurrent and primary breast cancer, define and review the expected breast imaging findings after breast conservation therapy and oncoplastic reconstruction, provide current imaging recommendations for patients with a personal history of breast cancer, and provide a case-based review of imaging features of breast cancer recurrence on mammography, sonography, magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging after breast conservation therapy.
Recent Findings
An increasing number of patients undergo breast conservation therapy due to the evolution of breast cancer treatment. New functional imaging modalities, such as contrast-enhanced mammography and molecular breast imaging, have recently become part of the expanding repertoire of breast imaging modalities that can be utilized in screening patients after breast conservation therapy.
Summary
As surgical techniques for breast cancer have evolved, more patients are undergoing breast conservation therapy with oncoplastic reconstruction. Accurate and prompt diagnosis is critical in guiding the appropriate management of breast cancer recurrence as it impacts treatment decisions, prognosis, and patient outcomes. Breast radiologists should have knowledge of expected postoperative imaging findings and of findings that are suspicious for recurrence on all available breast imaging modalities.
Similar content being viewed by others
Data Availability
Not applicable.
References
Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance
American Cancer Society. Key statistics for breast cancer. https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html#:~:text=At%20this%20time%20there%20are,Survival%20Rates%20for%20Breast%20Cancer. Revised January 12, 2023. Accessed 12 Sept 2023.
Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24(13):2028–37. https://doi.org/10.1200/JCO.2005.04.3273.
Kirova YM, De Rycke Y, Gambotti L, et al. Second malignancies after breast cancer: the impact of different treatment modalities. Br J Cancer. 2008;98(5):870–4. https://doi.org/10.1038/sj.bjc.6604241.
Chen Y, Thompson W, Semenciw R, Mao Y. Epidemiology of contralateral breast cancer. Cancer Epidemiol Biomarkers Prev. 1999;8(10):855–61.
Yi M, Huo L, Koenig KB, et al. Which threshold for ER positivity? a retrospective study based on 9639 patients. Ann Oncol. 2014;25(5):1004–11. https://doi.org/10.1093/annonc/mdu053.
Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg. 2014;149(3):267–74. https://doi.org/10.1001/jamasurg.2013.3049.
•De la Cruz KuG, Karamchandani M, Chambergo-Michilot D, et al. Does breast-conserving surgery with radiotherapy have a better survival than mastectomy? A meta-analysis of more than 1,500,000 patients. Ann Surg Oncol. 2022;29(10):6163–88. https://doi.org/10.1245/s10434-022-12133-8. (Meta-analysis comparing overall survival of BCT versus mastectomy found that overall survival is better in patients undergoing BCT compared with mastectomy).
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333(22):1456–61. https://doi.org/10.1056/NEJM199511303332203.
Bertozzi N, Pesce M, Santi PL, Raposio E. Oncoplastic breast surgery: comprehensive review. Eur Rev Med Pharmacol Sci. 2017;21(11):2572–85.
Chansakul T, Lai KC, Slanetz PJ. The postconservation breast: part 1, Expected imaging findings. AJR Am J Roentgenol. 2012;198(2):321–30. https://doi.org/10.2214/AJR.10.7298.
Sia J, Moodie K, Bressel M, et al. A prospective study comparing digital breast tomosynthesis with digital mammography in surveillance after breast cancer treatment. Eur J Cancer. 2016;61:122–7. https://doi.org/10.1016/j.ejca.2016.04.007.
Drukteinis JS, Gombos EC, Raza S, Chikarmane SA, Swami A, Birdwell RL. MR imaging assessment of the breast after breast conservation therapy: distinguishing benign from malignant lesions. Radiographics. 2012;32(1):219–34. https://doi.org/10.1148/rg.321115016.
•Chikarmane SA, Cochon LR, Khorasani R, Sahu S, Giess CS. Screening mammography performance metrics of 2D digital mammography versus digital breast tomosynthesis in women with a personal history of breast cancer. AJR Am J Roentgenol. 2021;217(3):587–94. https://doi.org/10.2214/AJR.20.23976. (Study specifically evaluating the screening performance digital breast tomosynthesis versus full field digital mammography specifically in women with a history of breast cancer found that for patients with a personal history of breast cancer and nondense breast tissue, DBT reduces recall rate and improves sensitivity/specificity).
Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 2018;15(3 pt A):408–14. https://doi.org/10.1016/j.jacr.2017.11.034.
American Cancer Society. Breast cancer facts and figures 2017–2018. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf. 2017. Accessed 12 Sept 2023.
••Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast cancer screening for women at higher-than-average risk: updated recommendations from the ACR. J Am Coll Radiol. 2023. https://doi.org/10.1016/j.jacr.2023.04.002. (Provides the latest screening guidelines for all high-risk women, including women with a personal history of breast cancer).
Lee JM, Ichikawa LE, Wernli KJ, et al. Digital mammography and breast tomosynthesis performance in women with a personal history of breast cancer, 2007–2016. Radiology. 2021;300(2):290–300. https://doi.org/10.1148/radiol.2021204581.
Candelaria RP, Hansakul P, Thompson AM, et al. Analysis of stereotactic biopsies performed on suspicious calcifications identified within 24 months after completion of breast conserving surgery and radiation therapy for early breast cancer: Can biopsy be obviated? Am J Surg. 2018;215(4):693–8. https://doi.org/10.1016/j.amjsurg.2017.06.032.
••Pathanasethpong P, Nawapun S, Chadbunchachai P, Somintara O, Apivatanasiri C, Boonrod A. The diagnostic accuracy of mammography and ultrasonography for recurrent breast cancer after breast conserving treatment. Eur J Radiol Open. 2023;11:100514. https://doi.org/10.1016/j.ejro.2023.100514. (Focuses specifically on mammographic and sonographic findings associated with tumor recurrence in women with a personal history of breast cancer who have undergone BCT).
Lehman CD, Lee JM, DeMartini WB, et al. Screening MRI in women with a personal history of breast cancer. J Natl Cancer Inst. 2016;108(3):djv349. https://doi.org/10.1093/jnci/djv349.
Gweon HM, Cho N, Han W, et al. Breast MR imaging screening in women with a history of breast conservation therapy. Radiology. 2014;272(2):366–73. https://doi.org/10.1148/radiol.14131893.
Wernli KJ, Ichikawa L, Kerlikowske K, et al. Surveillance breast MRI and mammography: comparison in women with a personal history of breast cancer. Radiology. 2019;292(2):311–8. https://doi.org/10.1148/radiol.2019182475.
Li J, Dershaw DD, Lee CH, Joo S, Morris EA. Breast MRI after conservation therapy: usual findings in routine follow-up examinations [published correction appears in AJR Am J Roentgenol. 2010 Oct;195(4):1043. Lee, Carol F [corrected to Lee, Carol H]]. AJR Am J Roentgenol. 2010;195(3):799–807. https://doi.org/10.2214/AJR.10.4305.
Solomon B, Orel S, Reynolds C, Schnall M. Delayed development of enhancement in fat necrosis after breast conservation therapy: a potential pitfall of MR imaging of the breast. AJR Am J Roentgenol. 1998;170(4):966–8. https://doi.org/10.2214/ajr.170.4.9530045.
Atallah D, Moubarak M, Arab W, El Kassis N, Chahine G, Salem C. MRI-based predictive factors of axillary lymph node status in breast cancer. Breast J. 2020;26(11):2177–82. https://doi.org/10.1111/tbj.14089.
Sorin V, Yagil Y, Yosepovich A, et al. Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol. 2018;211(5):W267–74. https://doi.org/10.2214/AJR.17.19355.
Dromain C, Balleyguier C, Adler G, Garbay JR, Delaloge S. Contrast-enhanced digital mammography. Eur J Radiol. 2009;69:34–42.
Helal MH, Mansour SM, Ahmed HA, Abdel Ghany AF, Kamel OF, Elkholy NG. The role of contrast-enhanced spectral mammography in the evaluation of the postoperative breast cancer. Clin Radiol. 2019;74(10):771–81. https://doi.org/10.1016/j.crad.2019.06.002.
Jong RA, Yaffe MJ, Skarpathiotakis M, et al. Contrast-enhanced digital mammography: initial clinical experience. Radiology. 2003;228:842–50.
Sung JS, Lebron L, Keating D, et al. Performance of dual-energy contrast-enhanced digital mammography for screening women at increased risk of breast cancer. Radiology. 2019;293(1):81–8. https://doi.org/10.1148/radiol.2019182660.
Hruska CB, Corion C, de Geus-Oei L, Adrada BE, Fowler A, Hunt K, et al. SNMMI procedure standard/EANM practice guideline for molecular breast imaging with dedicated gamma-cameras. J Nuc Med. 2022;50(2):103–10. https://doi.org/10.2967/jnmt.121.264204.
Huppe AI, Mehta AK, Brem RF. Molecular breast imaging: a comprehensive review. Semin Ultrasound CT MR. 2018;39:60–9.
American College of Radiology. ACR practice parameter for the performance of molecular breast imaging (MBI) using a dedicated gamma camera. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/MBI.pdf. Accessed 14 Oct 2022.
Cwikla JB, Kolasinska A, Buscombe JR, Hilson AJ. Tc-99m MIBI in suspected recurrent breast cancer. Cancer Biother Radiopharm. 2000;15(4):367–72. https://doi.org/10.1089/cbr.2000.15.367.
Kolasińska AD, Buscombe JR, Cwikła JB, et al. The role of scintimammography and mammography in recurrent breast cancer. Evaluation of their accuracy using ROC curves. Nucl Med Rev Cent East Eur. 2001;4(2):77–82.
Acknowledgements
We thank Dr. Olena Weaver for her contribution to the contrast-enhanced mammography Figure 4.
Funding
We acknowledge the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA016672.
Author information
Authors and Affiliations
Contributions
MP, BA, EN, MK, LK, MG, FP, TM, and EA all contributed to the article’s conception and design. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Competing interest
Not applicable.
Ethical Approval
Not applicable.
Research Involved in Human and Animal Participants
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Patel, M.M., Adrada, B.E., Nia, E.S. et al. Multimodality Imaging of Breast Cancer Recurrence Post Breast Conservation Therapy. Curr Radiol Rep 12, 9–18 (2024). https://doi.org/10.1007/s40134-023-00422-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40134-023-00422-3