title: Imaging Surveillance After Primary Breast Cancer Treatment.
abstract: OBJECTIVE
  Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen.
  
  
  CONCLUSIONS
  Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.
authors.affiliation: 1 Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G2-600, Seattle, WA 98109-1023.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Lam
authors.affiliation: 2 Screening and Test Evaluation Program, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.affiliation: 1 Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G2-600, Seattle, WA 98109-1023.
authors.forename: Janie M
authors.initials: JM
authors.lastname: Lee
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods / Q000592:standards*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods / Q000592:standards*
keywords: breast MRI; breast ultrasound; digital breast tomosynthesis; imaging surveillance after primary breast cancer treatment; mammography