The role of US and MR imaging in detecting local chest wall tumor recurrence after mastectomy.
OBJECTIVE
To determine the role of clinical examination, ultrasonography (US), and magnetic resonance imaging (MRI) in detecting local tumor recurrence in patients who underwent modified radical mastectomy for breast cancer.


METHODS
The study included 27 patients who were examined between April 1999 and April 2003. US evaluation of the chest wall was performed in all patients. MRI was performed on 10 patients due to suspicious findings in clinical examination, on 3 patients due to US findings, and on 8 patients due to both US and clinical examination findings. Six patients without any suspicious findings underwent MRI for follow-up purposes. The lesions detected with MRI were evaluated according to their morphology, contrast enhancement characteristics and dynamics. The focal lesions that enhanced intensely at the early phase were accepted as suspicious for malignancy.


RESULTS
Of the 10 cases that underwent biopsy secondary to suspicious lesions for malignancy according to MRI findings, 7 were found to have recurrence. In the remaining 3 patients, recurrence diagnosis was made based on the fact that the lesions regressed in response to chemotherapy. In 17 cases, there were no suspicious findings on MRI for local recurrence. In 2 of these cases, biopsies were performed due to suspicious US findings; however, no malignancies were detected. The sensitivity and specificity of clinical examination in detecting local recurrence was 70% and 35.2%, respectively. These values were 90% and 88.2% for US, and 100% and 100% for MRI.


CONCLUSIONS
In patients with mastectomy, US and MRI were more successful in detecting local recurrence than clinical examination. Considering the fact that US is cheaper and more readily available than MRI, it should be part of the routine follow-up in order to detect local recurrence early. MRI will be helpful in cases with suspicious US findings by increasing the specificity of the evaluation as well as determining the actual size and spread of any lesions, which is valuable information for the subsequent management and response to the particular treatment.
Yilmaz
Mehmet Halit
MH
Department of Radiology, Istanbul University, Cerrahpaşa School of Medicine, Istanbul, Turkey. drmhyilmaz@yahoo.com
Esen
Gül
G
Ayarcan
Yasemin
Y
Aydoğan
Fatih
F
Ozgüroğlu
Mustafa
M
Demir
Gökhan
G
Beşe
Nuran
N
Mandel
Nil Molinas
NM
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013899:Thoracic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000473:pathology; D014421:Turkey / Q000453:epidemiology; D014463:Ultrasonography