title: Surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer: a systematic review.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer.
  
  
  METHODS
  A systematic review of surveillance mammography compared with ultrasound, magnetic resonance imaging (MRI), specialist-led clinical examination or unstructured primary care follow-up, using histopathological assessment for test positives and follow-up for test negatives as the reference standard.
  
  
  RESULTS
  Nine studies met our inclusion criteria. Variations in study comparisons precluded meta-analysis. For routine ipsilateral breast tumour detection, surveillance mammography sensitivity ranged from 64-67% and specificity ranged from 85-97%. For MRI, sensitivity ranged from 86-100% and specificity was 93%. For non-routine ipsilateral breast tumour detection, sensitivity and specificity for surveillance mammography ranged from 50-83% and 57-75% and for MRI 93-100% and 88-96%. For routine metachronous contralateral breast cancer detection, one study reported sensitivity of 67% and specificity of 50% for both surveillance mammography and MRI.
  
  
  CONCLUSIONS
  Although mammography is associated with high sensitivity and specificity, MRI is the most accurate test for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer. Results should be interpreted with caution because of the limited evidence base.                                                     Key Points                                                  • Surveillance mammography is associated with high sensitivity and specificity                                                  • Findings suggest that MRI is the most accurate test for detecting further breast cancer                                                  • Robust conclusions cannot be made due to the limited evidence base                                                  • Further research comparing surveillance mammography and other diagnostic tests is required.
authors.affiliation: Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, UK. c.robertson@abdn.ac.uk
authors.forename: Clare
authors.initials: C
authors.lastname: Robertson
authors.forename: Senthil Kumar Arcot
authors.initials: SK
authors.lastname: Ragupathy
authors.forename: Charles
authors.initials: C
authors.lastname: Boachie
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fraser
authors.forename: Steve D
authors.initials: SD
authors.lastname: Heys
authors.forename: Graeme
authors.initials: G
authors.lastname: Maclennan
authors.forename: Graham
authors.initials: G
authors.lastname: Mowatt
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Thomas
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Gilbert
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography / Q000379:methods; D008403:Mass Screening; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D010173:Palpation; D011159:Population Surveillance; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D014463:Ultrasonography