Accuracy of Mammo post lumpectomy & rads

cp418

I'm currently researching details of accuracy of mammogram post lumpectomy and radiation therapy. I have some fibrotic changes in my left lung where rads applied. I am not comfortable with yearly mammogram and now this articel confirms my opinion. Joann

http://radiographics.rsnajnls.org/cgi/content/full/24/5/1269


Local and Regional Recurrence and Metastases
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Abstract
LEARNING OBJECTIVES FOR TEST...
Introduction
Treatment-related Manifestations
Local and Regional Recurrence...
Conclusions
References


Local and regional sites constitute the most common sites of soft-tissue recurrence of breast cancer. The most common distant sites of metastasis are bone and lung. Intrathoracic metastasis from breast cancer commonly involves the lungs, pleura, mediastinum, and airway (38).
Local recurrence is the reappearance of tumor at the surgical site. Regional recurrence is defined as the appearance of metastases in the lymph nodes that drain the breast, including the supraclavicular, axillary, and internal mammary nodes. The likelihood of local or regional recurrence is greater in patients who have not received postoperative radiation therapy and in those with large primary tumors, positive margins, multiple cancers at the time of initial presentation, and positive lymph nodes (38,39).

Local recurrence is evaluated primarily with physical examination that includes the surgical site, axilla, supraclavicular fossa, and neck. Mammography is an important adjunct to physical examination in the follow-up of breast cancer patients who have been treated with BCS. However, the ability of mammography to help detect local recurrence is compromised by the presence of postoperative distortion and the increased density of the irradiated breast. Mammography is able to help detect only two-thirds of recurrences in postlumpectomy patients (39). Rissanen et al (40) evaluated the usefulness of mammography and US for the diagnosis of local recurrence following mastectomy. The sensitivity of US was 91%, whereas the sensitivities of clinical examination and mammography were 79% and 45%, respectively.

CT has been shown to delineate more clearly than physical examination the extent of recurrent breast carcinoma following mastectomy and is of great value in treatment planning (41–43). CT findings in local recurrence include focally thickened skin to a depth greater than 1 cm (soft-tissue window); dense, mass-like accumulation of soft tissue within the subcutaneous fat; and obvious masses within the chest wall muscles (Fig 13). Contour irregularities or CT inhomogeneity of the muscle can indicate recurrence (43). Sometimes residual muscle also mimics local recurrence (Fig 14).