Magnetic Resonance Imaging after Breast Oncoplastic Surgery: An Update

Abstract

Breast-oncoplastic surgery, allowing local tumor control and a better cosmetic outcome, is oncologically safe when applied to early-stage breast cancer. Breast cancer recurrence following conservative therapy may occur during the first 5 years after treatment, with a peak incidence after 2 years. Therefore, during the follow-up period, patients undergo a series of ultrasound (US) and mammographic examinations. However, after surgery and radiation therapy, several modifications occur in the treated breast, causing difficulties in image interpretation, especially when local recurrence is suspected. Although not included in routine follow-up, magnetic resonance imaging (MRI) is often used in clinical practice, being considered more sensitive than the conventional imaging examinations in discriminating between postsurgical tissue modifications and tumor recurrence. In this review article, we analyze expected and pathologic breast MRI findings after conservative oncoplastic surgery compared to US and mammographic findings in order to distinguish local recurrence and avoid potential pitfalls in image interpretation.

US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography

“…There are several methods that show high sensitivity for the detection of breast lesions, e. g. combined use of ultrasound (US) and mammography can reach sensitivity ranging from 92.6 % to 94.4 % in different studies, but with limited specificity in the differentiation of malignant from benign lesions of up to 67.9 % [1,2]. A similar tendency regarding contrast-enhanced MRI for breast lesions has been published, showing high sensitivity (94 %-100 %), especially for the assessment of tumor vascularity, but poor specificity regarding the differentiation of lesions (37-86 %) [3][4][5][6][7][8].…”

Lipofilling Outcomes Mimicking Breast Cancer Recurrence: Case Report and Update of the Literature

“…The most frequent complication was liponecrosis. Among different studies, the incidence of fat necrosis was, however, extremely variable, also depending on the lipofilling technique used (15)(16)(17). Usually liponecrosis is asymptomatic, sometimes patients may present local ecchymosis or a palpable mass.…”

“…Usually liponecrosis is asymptomatic, sometimes patients may present local ecchymosis or a palpable mass. On mammographic examination, liponecrosis may appear as a radiolucent rounded image surrounded by a thin radiopaque rib (16,17). The presence of calcifications on mammographic examination may lead to a suspicion of breast cancer relapse, especially at the first stage of the process when the calcifications present small size (17,18).…”

“…On mammographic examination, liponecrosis may appear as a radiolucent rounded image surrounded by a thin radiopaque rib (16,17). The presence of calcifications on mammographic examination may lead to a suspicion of breast cancer relapse, especially at the first stage of the process when the calcifications present small size (17,18). The imaging findings on US examination may be misleading, presenting as a structural inhomogeneity of the subcutaneous fat tissue or a hypoechoic aspect with blurred margins and posterior acoustic shadowing (16).…”

Second-Look Ultrasound Using Shear-Wave Elastography in MRI-Suspected Locoregional Recurrence of Breast Carcinoma

“…However, a recent survey by the European Society of Breast Imaging (EUSOBI) has shown that approximately 45 % of participants use MRI for the detection of LR after BCS [12]. This can lead to an increased number of false-positive findings, due to postoperative changes which may result in post-contrast enhancement on T1 sequences, such as early scarring, seroma, and fat necrosis [13,14]. Suspicious lesions detected by breast MRI are commonly assessed and biopsied under guidance of a targeted ultrasound (US) examination ("second-look" US) [15,16].…”