Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer.
OBJECTIVE
To evaluate findings from routine mammographic screenings in patients with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions.


METHODS
During a 25-month study period, 214 consecutive screening mammograms in 113 asymptomatic women (mean age, 51 years) with TRAM flap reconstructions were obtained. Mastectomies were performed for cancer in 106 (94%) of the 113 women and for prophylaxis in seven (6%). Prospectively, a Breast Imaging Reporting and Data System (BI-RADS) assessment category 1-5 was assigned to each mammogram. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed. CIs were determined by the normal approximation to the binomial distribution.


RESULTS
Seven (3%) of 214 examinations were BI-RADS category 4 or 5. Six (86%) of seven patients underwent biopsy. Two (33%) of these six biopsies demonstrated invasive ductal carcinoma. Cancer detection rate for mammography was 1.9% (two of 106) (95% CI: 0.33%, 7.32%) for women with reconstruction for breast cancer during the 2-year period. One (6%) of 16 BI-RADS category 3 examinations later proved to be invasive ductal carcinoma at follow-up. No interval cancer was discovered in 171 cases of BI-RADS category 1 or 2 examinations with 1-year follow-up. No cancers occurred in women who underwent prophylactic mastectomy. A biopsy positive predictive value of 33% (95% CI: 6%, 76%) was observed.


CONCLUSIONS
Screening mammography of TRAM flap-reconstructed breasts enables detection of nonpalpable cancer before clinical examination.
Helvie
Mark A
MA
Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, Taubman Center 2910N, Ann Arbor, MI 48109-0326, USA.
Bailey
Janet E
JE
Roubidoux
Marilyn A
MA
Pass
Helen A
HA
Chang
Alfred E
AE
Pierce
Lori J
LJ
Wilkins
Edwin G
EG
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps