Ultrasonographic detection of occult cancer in patients after surgical therapy for breast cancer.
OBJECTIVE
The purpose of this study was to investigate the efficacy of ultrasonography in detecting an occult malignancy after surgery for breast cancer and to assess the imaging and clinical findings associated with a recurrence.


METHODS
During a 4-year period, 3329 bilateral whole-breast ultrasonographic examinations were performed to detect occult malignancies clinically and mammographically in 1968 asymptomatic patients after breast cancer surgery. All questionable lesions were confirmed with ultrasonographically guided intervention. This study reviewed ultrasonographic findings and pathologic results of the questionable lesions along with the clinical parameters of the patients. We searched for false-negative cases from the hospital database.


RESULTS
Among the 1968 patients, ultrasonography revealed questionable lesions in 57 (2.9%). The questionable lesions were lymph nodes in 42 and masses in 15; of these lesions, 24 were malignant (true-positive) and 33 were benign (false-positive). Ten false-negative cases were identified. The sensitivity and specificity were 70.6% and 98.3%, respectively. The locations of the recurrent lesions were the regional lymph nodes in 14 cases (4, axillary fossa; 4, interpectoral; 4, internal mammary; and 2, supraclavicular lymph nodes) and the breast and mastectomy bed in 7 cases. The mean size of the malignant lymph nodes was larger than that of the benign lymph nodes. Among those with positive examination results, the clinical parameters in the recurrent and nonrecurrent groups were similar.


CONCLUSIONS
Postoperative follow-up ultrasonography showed occult malignancies clinically and mammographically in 1.2% of the patients who had been treated for breast cancer. Familiarity with the common location of a tumor recurrence is essential for making an accurate ultrasonographic evaluation in these patients.
Shin
Jung Hee
JH
Department of Radiology, Sungkyunkwan University, School of Medicine, Samsung Medical Center 135-230, Ilwon-Dong, Seoul, Korea.
Han
Boo-Kyung
BK
Choe
Yeon Hyeon
YH
Nam
Seok-Jin
SJ
Park
Won
W
Im
Young-Hyuck
YH
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary