What is the preferred exam for postsurgical breast imaging?

Updated: Dec 19, 2018
  • Author: Susan Ackerman, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

The workup of postsurgical breast changes includes a thorough mammographic evaluation and correlation with the clinical history and pathologic findings. Scar markers are helpful to document the surgical approach. Additional mammographic projections (tangential, compression, and/or magnification views), comparison with prior mammograms, clinical breast examination, and ultrasonography are helpful in the workup. Tissue sampling is recommended for any suspicious or indeterminate findings. Breast MRI may also be helpful in the evaluation of postsurgical changes. [6, 7, 8]

The development of pleomorphic microcalcifications, especially in a branching pattern, is regarded as highly suggestive of new or recurrent cancer. Biopsy should be performed promptly. The development of oil cysts or fat necrosis is common, and routine follow-up can be performed. Architectural distortion is a common mammographic finding after breast conservation surgery and should be closely monitored after an appropriate workup is performed (with magnification and/or compression views). Any developing or changing area of architectural distortion should be viewed as worrisome. Skin and trabecular thickening frequently are observed after radiation therapy.

Mammographic and ultrasonographic findings of malignant and benign lesions overlap. A thorough workup is needed for any new or changing mass, developing calcifications, and developing areas of architectural distortion or density. Biopsy should be considered for any indeterminate or suspicious findings.

Scar markers are helpful to document the surgical approach. Additional mammographic projections (tangential, compression, and/or magnification views), comparison with prior mammograms, clinical breast examination, and ultrasonography are helpful in the workup. Tissue sampling is recommended for any suspicious or indeterminate findings. [9, 6]  Scintimammography is best used in clinical scenarios where mammography and ultrasound are inconclusive. [10]

Digital breast tomosynthesis (DBT) entails imaging of the breast tissue in multiple sections (at varied angles) instead of a 2-dimensional image, as with conventional mammography. DBT helps in triangulation of a lesion and can reduce the requirement for additional views. [3]


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