title: Does surgical closure technique affect early mammographic detection of tumor recurrence after breast-conserving therapy?
abstract: OBJECTIVE
  Scarring in the tumor bed may mask or mimic local recurrence of tumor on surveillance mammography. Type of surgical closure technique used during lumpectomy may impact the pattern or density of scar tissue apparent in the tumor bed on mammography. This study sought to determine whether surgical closure type affects tumor-bed scar formation and impacts interpretation of surveillance mammography in women treated with breast-conserving therapy for early-stage breast cancer.
  
  
  METHODS
  One hundred women who received breast-conserving therapy were selected; 99 of them had 2-year post-treatment mammograms for the treated breast. Craniocaudal and mediolateral oblique views were reviewed by 3 subspecialty radiologists who routinely read mammograms. The mammograms were scored on 5-point scales for overall breast density and scarring within the tumor bed.
  
  
  RESULTS
  The analyses did not demonstrate greater scarring or density in breast status post superficial closure compared with breast status post full-thickness closure, or vice versa (P > 0.05 for scarring and density). There were no detectable differences between the 2 closure techniques either within the data from individual reviewers, within the composite data for the entire group of reviewers, or in instances where 2 of 3 reviewers agreed (P > 0.05). There was significant interobserver variability in scoring among the mammographers for both scarring (P = 0.001) and density (P < 0.0001).
  
  
  CONCLUSIONS
  Based on our study of the 2-year post-treatment mammograms, there was no evidence that closure technique impacts degree of scarring in the tumor bed. However, striking interobserver variability in scoring density and scarring was noted.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Newlin
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Indelicato
authors.forename: Patricia
authors.initials: P
authors.lastname: Abbitt
authors.forename: Julia
authors.initials: J
authors.lastname: Marshall
authors.forename: David
authors.initials: D
authors.lastname: Wymer
authors.forename: Stephen
authors.initials: S
authors.lastname: Grobmyer
authors.forename: Linda
authors.initials: L
authors.lastname: Haigh
authors.forename: Edward
authors.initials: E
authors.lastname: Copeland
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Mendenhall
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D015588:Observer Variation; D012008:Recurrence; D058106:Wound Closure Techniques