title: Mammography before post-operative radiotherapy in conservatively managed breast cancer patients: is it useful?
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of bilateral mammography undertaken before adjuvant radiotherapy in patients with conservatively managed invasive carcinoma of the breast.
  
  
  METHODS
  Patients with invasive breast cancer referred to the Radiotherapy Unit of the Università Cattolica del Sacro Cuore, in Campobasso, Italy, between March 2002 and September 2006 were retrospectively reviewed. Patients were referred to our facility from other local and regional hospitals where they received breast-conserving surgery and adjuvant chemotherapy. They presented to our department for post-operative whole-breast radiotherapy. All patients underwent physical examination and bilateral mammography prior to adjuvant irradiation.
  
  
  RESULTS
  201 patients met the selection criteria as delineated. Of these 201 patients who underwent pre-radiotherapy mammography, 3 had suspicious findings on mammography. In two of those cases, the histopathological examination confirmed the presence of residual disease within the residual mammary gland. In one case, the pre-radiotherapy mammogram allowed for the detection of disease persistence which was not otherwise appreciated on physical exam. In the other case, the diagnostic imaging confirmed only the findings of the physical exam. In both cases of residual disease, the tumour was found elsewhere in the breast and not at the primary site. In one patient, the radiological re-assessment led to a false-positive result. No cases of contralateral synchronous breast cancer were observed. The overall adjunctive cost of this strategy including a routine mammography besides the clinical visit was €7012 for all patients.
  
  
  CONCLUSIONS
  No clear recommendation exists regarding post-operative mammography before adjuvant radiotherapy. In our experience, this strategy allowed for the detection of gross disease persistence after surgery which was not appreciated at clinical examination in 1 case out of 201. In this patient, adjuvant radiotherapy up to a total dose of 50 Gy would have been inadequate. Given the low cost of mammography, further investigation about its role in pre-radiotherapy evaluation is warranted.
authors.affiliation: Radiotherapy Unit, Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Massaccesi
authors.forename: C
authors.initials: C
authors.lastname: Digesù
authors.forename: G
authors.initials: G
authors.lastname: Macchia
authors.forename: F
authors.initials: F
authors.lastname: Deodato
authors.forename: M
authors.initials: M
authors.lastname: Ciuffreda
authors.forename: E
authors.initials: E
authors.lastname: Cucci
authors.forename: L
authors.initials: L
authors.lastname: Caravatta
authors.forename: G
authors.initials: G
authors.lastname: Corrado
authors.forename: G D A
authors.initials: GD
authors.lastname: Padula
authors.forename: R
authors.initials: R
authors.lastname: De Vizia
authors.forename: N
authors.initials: N
authors.lastname: Cellini
authors.forename: V
authors.initials: V
authors.lastname: Valentini
authors.forename: G
authors.initials: G
authors.lastname: Sallustio
authors.forename: G
authors.initials: G
authors.lastname: Ferrandina
authors.forename: F
authors.initials: F
authors.lastname: Pacelli
authors.forename: A G
authors.initials: AG
authors.lastname: Morganti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008327:Mammography / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D018365:Neoplasm, Residual; D011182:Postoperative Care / Q000379:methods; D015995:Prevalence; D011379:Prognosis; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014600:Utilization Review