Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography

Abstract

Background To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). Methods The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated. Results A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7–2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler. Conclusion AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.

Imaging features of acellular dermal matrix in the reconstructed breast after breast cancer

“…The literature describes a spectrum of imaging findings for ADM on various modalities. AlloDerm appears as an equal to high density mass on mammography without obscuration of calcifications [7,8,10]. On ultrasound, AlloDerm has been described as isoechoic to hypoechoic masses with smooth margins and variable internal color flow [8,10,11].…”

“…AlloDerm appears as an equal to high density mass on mammography without obscuration of calcifications [7,8,10]. On ultrasound, AlloDerm has been described as isoechoic to hypoechoic masses with smooth margins and variable internal color flow [8,10,11]. On MRI, AlloDerm was isointense to glandular tissue on non-contrast fat-saturated T1-weighted images, hyperintense on fat-saturated T2-weighted images, and had variable post-contrast enhancement [7,8,10,12].…”

Imaging features of volume replacement using an acellular dermal matrix in oncoplastic breast conserving surgery: A case report

“…They may appear as iso-to-hypoechoic masses with a folded, sheet-like structure with posterior acoustic shadowing, and with or without color flow [7 , 8] . On MRI, an ADM shows iso-signal intensity to glandular tissue in a non fat-satured T1-weighted image, and low signal intensity in a fat-saturated T2-weighted image with none to mild dynamic contrast enhancement [4 , 8 , 9] .…”

Acellular Dermal Matrix Mimicking a New Retroareolar Mass After Central Pillar Neonipple Reconstruction

“…Lee et al 2 describes 3 cases where ADM seemed as circumscribed masses isodense to glandular tissue without obscuring calcifications, similar to findings of Tran et al, 3 although these studies used ADM as a hammock/sling or to fill lumpectomy defects, not in neonipple reconstruction. To increase detection of local tumor recurrence, Young Kim et al 15 suggested using the surveillance-abbreviated magnetic resonance imaging for patients who underwent breast-conserving therapy with ADM, which demonstrated a high sensitivity in detecting ipsilateral local tumor recurrence without delayed diagnosis as a result of postoperative changes with ADM filler.…”