Diagnostic value of palpation and ultrasonography for diagnosing breast cancer recurrence after mastectomy--a comparison.
OBJECTIVE
According to the current interdisciplinary S 3 guideline for breast cancer diagnostics, treatment, and follow-up (1st update 2008), palpation is one of the diagnostic mainstays for follow-up examinations after mastectomy. Although recommended in the manuscript, regular ultrasonographic examinations are neither explicitly mentioned in the statement nor in the follow-up plan. In ambiguous cases, MRI can serve as a supplementary diagnostic method. In order to evaluate the value of palpation and ultrasonography for diagnosing recurrent disease after mastectomy, we analyzed the sensitivity of each method individually and the sensitivity of both methods combined.


METHODS
Over a 12-year time span, histological data from 57 patients suspected to have recurrent disease after mastectomy (benign lesions: n = 15, 26.3% malignant lesions: n = 42, 73.7%) were collected. Prior to biopsy, the benign versus malignant character of all lesions was assessed by palpation and ultrasonography (BI-RADS). Sensitivity, specificity, positive predictive value (ppv), negative predictive value (npv), and efficacy were calculated using a contingency table.


RESULTS
Palpation had a sensitivity of 85.7 % and a specificity of 6.7% the respective figures for ultrasonography were 90.5% and 46.7%. The sensitivity of palpation and ultrasonography combined was 100%, i. e. 14.3% higher than the sensitivity of palpation alone. Five cases of recurrent disease which remained undetected by palpation were only recognized by ultrasonography.


CONCLUSIONS
In agreement with several other studies, the results of our retrospective study show that ultrasonography is superior to palpation for diagnosing recurrent disease after mastectomy. Prospective multicenter studies are needed to evaluate ultrasonographic follow-up before an amendment of the current S 3 guidelines can be recommended with a high degree of evidence.
Günther-Tritsch
K
K
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ernst-Moritz-Arndt-Universität Greifswald. k1967@aol.com
Bojahr
B
B
Ohlinger
R
R
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D010173:Palpation; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*