The Value of Postexcision Preradiation Mammography in Patients With Early-Stage Breast Cancer

Abstract

The purpose of this study was to evaluate the benefit of postexcision preradiation mammography for patients with early-stage breast cancer. The records of 101 patients (103 breasts) with either ductal carcinoma in situ (DCIS) or early invasive breast cancer diagnosed based on microcalcifications on a mammogram between January 1999 and December 2001 at our institution were reviewed. Sixty-one patients had a postexcision preradiation mammogram, and 42 patients did not have a mammogram until the completion of radiation. Of the 61 patients who had a preradiation mammogram, 1 patient (2%) was found to have residual microcalcifications after the completion of chemotherapy. A core biopsy revealed DCIS, and a wide excision revealed no additional abnormalities. Of the 42 patients who underwent a postradiation mammogram, 1 patient had calcifications in the same quadrant as her original biopsy. A wide excision revealed only sclerosing adenosis. For women who receive chemotherapy before the initiation of radiation, a preradiation mammogram ought to be considered because there will frequently be a 6-month interval from the patient's lumpectomy to the initiation of radiation. However, for women scheduled to start radiation within an interval of 4 months or less, our data do not support the routine use of postexcision preradiation mammography. Although we recognize that our data may not be representative of the community at large, our observations do not support the routine use of postexcision preradiation mammography in women with small breast cancers.

The Role of Mammography after Breast-Conserving Surgery and Adjuvant Chemotherapy

“…To our knowledge this is the largest study evaluating locoregional restaging after BCS and chemotherapy by mammogram and its impact on the waiting time for radiotherapy. A few studies evaluated the use of preradiotherapy mammograms in patients presenting presurgical suspicious calcifications 4,5 . A previous study conducted by Teixidor et al 6 investigated the value of mammography after BCS before radiotherapy including 120 patients with breast cancer regardless of the presence or absence of microcalcifications on their diagnostic mammograms.…”

“…However, there is no universal agreement about the utility of preradiotherapy mammograms. Previous studies have focused on the role of preradiotherapy mammograms in patients with a preoperative mammogram with suspicious microcalcifications leading to the diagnosis of breast cancer 4,5 . These studies supported the use of postexcision preradiotherapy mammogram if preexcision microcalcifications were present, with the highest positive predictive value being found in patients with ductal in situ carcinomas 4 .…”

Prediction of Residual Malignancy After Excisional Biopsy for Breast Cancer With Suspicious Microcalcifications: Comparison of Mammography and Magnetic Resonance Imaging

“…Second, the rates of residual suspicious calcifications on post-excision mammography and residual malignancy in our study was higher than those previously reported. 12,25,26 However, excisions were performed in our study for pathologic confirmation and not for complete tumor removal.…”

“…Mammography may be able to establish a baseline for radiologic follow-up but whether it helps to determine the adequacy of tumor excision is controversial. [12][13][14][15][16] Diagnostic assessment of the postoperative breast is often challenging because inflammatory changes may be vague or mimic malignancy. 14,17,18 However, to perform a complete excision, it is important to accurately predict residual malignancy after excisional biopsy if suspicious microcalcifications are present.…”

Development of a nomogram to predict the clinical impact of a postexcision preirradiation mammogram

“…Postexcision preirradiation mammograms (PPMs) performed within a short time period after breast‐conserving surgery, but prior to adjuvant radiation, can be utilized to identify any radiographic evidence of residual disease. Previous attempts to ascertain the clinical benefit from a PPM have been hindered by small sample sizes and selection bias and have been retrospective in nature . Because only women considered to have a high risk of residual disease had postlumpectomy mammograms orders, many series likely overestimate the frequency of residual suspicious calcifications on PPM.…”