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Breast Imaging |
1 From the Departments of Radiology (M.A.H., J.E.B., M.A.R.), Surgery (H.A.P., A.E.C., E.G.W.), and Radiation Oncology (L.J.P.), University of Michigan Health System, 1500 E Medical Center Dr, Taubman Center 2910N, Ann Arbor, MI 48109-0326. From the 1999 RSNA scientific assembly. Received November 29, 2000; revision requested January 4, 2001; revision received September 24; accepted February 1, 2002. Address correspondence to M.A.H.
PURPOSE: To evaluate findings from routine mammographic screenings in patients with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions.
MATERIALS AND METHODS: During a 25-month study period, 214 consecutive screening mammograms in 113 asymptomatic women (mean age, 51 years) with TRAM flap reconstructions were obtained. Mastectomies were performed for cancer in 106 (94%) of the 113 women and for prophylaxis in seven (6%). Prospectively, a Breast Imaging Reporting and Data System (BI-RADS) assessment category 1–5 was assigned to each mammogram. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed. CIs were determined by the normal approximation to the binomial distribution.
RESULTS: Seven (3%) of 214 examinations were BI-RADS category 4 or 5. Six (86%) of seven patients underwent biopsy. Two (33%) of these six biopsies demonstrated invasive ductal carcinoma. Cancer detection rate for mammography was 1.9% (two of 106) (95% CI: 0.33%, 7.32%) for women with reconstruction for breast cancer during the 2-year period. One (6%) of 16 BI-RADS category 3 examinations later proved to be invasive ductal carcinoma at follow-up. No interval cancer was discovered in 171 cases of BI-RADS category 1 or 2 examinations with 1-year follow-up. No cancers occurred in women who underwent prophylactic mastectomy. A biopsy positive predictive value of 33% (95% CI: 6%, 76%) was observed.
CONCLUSION: Screening mammography of TRAM flap–reconstructed breasts enables detection of nonpalpable cancer before clinical examination.
© RSNA, 2002
Index terms: Breast neoplasms, 00.324 • Breast neoplasms, postoperative, 00.324 • Breast neoplasms, radiography, 00.111, 00.113, 00.114 • Breast radiography, 00.111, 00.113, 00.114
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