title: ACR Appropriateness Criteria® local-regional recurrence (LR) and salvage surgery: breast cancer.
abstract: Despite the success of both breast conserving surgery and mastectomy, some women will experience a local-regional recurrence (LRR) of their breast cancer. Predictors for LRR after breast-conserving therapy or mastectomy have been identified, including patient, tumor, and treatment-related factors. The role of surgery, radiation, and chemotherapy as treatment has evolved over time and many patients now have the potential for salvage after LRR. This review of LRR of breast cancer and management recommendations, including the use of common clinical scenarios, represents a compilation of evidence-based data and expert opinion of the American College of Radiology Appropriateness Criteria Expert Panel on local-regional recurrence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Mayo Clinic Scottsdale, AZ, USA. mhalyard@mayo.edu
authors.forename: Michele Y
authors.initials: MY
authors.lastname: Halyard
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Eleanor E R
authors.initials: EE
authors.lastname: Harris
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Arthur
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
authors.forename: Lisa
authors.initials: L
authors.lastname: Carey
authors.forename: Sharad
authors.initials: S
authors.lastname: Goyal
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Horst
authors.forename: Meena S
authors.initials: MS
authors.lastname: Moran
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor