Detecting nonpalpable recurrent breast cancer: the role of routine mammographic screening of transverse rectus abdominis myocutaneous flap reconstructions.
OBJECTIVE
To perform a retrospective cohort study to determine the rates of recall and cancer detection and then to develop a decision analytic model to evaluate the effectiveness of routine screening of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions.


METHODS
This study was approved by the institutional review board, and the methods comply with HIPAA regulations. A retrospective search of the institutional mammographic results database was done to identify bilateral screening mammographic examinations obtained from January 1, 1999, through July 15, 2005. The search included the term TRAM; the recall and cancer detetion rates were then detected. Subsequently, a decision analytic model was constructed to evaluate a hypothetical cohort of women with TRAM flap reconstructions.


RESULTS
Of 554 mammograms (265 TRAM flap reconstructions), 546 (98.6%) had negative results (Breast Imaging Reporting and Data System category 1 or 2). Eight (1.4%) had positive test results (Breast Imaging Reporting and Data System category 0, 3, 4, or 5). All suspicious lesions underwent biopsy and had benign pathologic results. No interval breast cancers were identified. The detection rate for nonpalpable recurrent breast cancer was 0% (exact 95% confidence interval: 0.0%, 1.4%). According to decision analysis, screening would help detect an estimated 12 additional recurrent cancers per 1000 women screened, providing an additional 1.6 days of life expectancy for the screened cohort. Under base-case conditions, screening of TRAM flap reconstructions is less effective than screening asymptomatic women in their 40s. Sensitivity analysis revealed that a benefit equivalent to that of screening asymptomatic women in their 40s was achievable under conditions related to estimates of screening effectiveness and cancer detection rate.


CONCLUSIONS
Routine screening mammography of TRAM flap reconstructions has a very low detection rate for nonpalpable recurrent breast cancer. Decision analysis indicates that screening such women is less effective than screening asymptomatic women in their 40s for primary breast cancer.
Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA. jlee45@partners.org
Janie M
JM
Lee
Dianne
D
Georgian-Smith
G Scott
GS
Gazelle
Elkan F
EF
Halpern
Elizabeth A
EA
Rafferty
Richard H
RH
Moore
Eren D
ED
Yeh
Helen A
HA
D'Alessandro
Rachel A
RA
Hitt
Daniel B
DB
Kopans
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome