title: Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer.
abstract: 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.
authors.affiliation: Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, Taubman Center 2910N, Ann Arbor, MI 48109-0326, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Helvie
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bailey
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Roubidoux
authors.forename: Helen A
authors.initials: HA
authors.lastname: Pass
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Chang
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Pierce
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: 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