Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease

Abstract.

The objective of the present study was the evaluation of MRI of the breast in the follow-up of patients who had undergone autogenous tissue breast reconstruction using either a latissimus-dorsi muscle flap or a transverse rectus abdominis myocutaneous (TRAM) flap as correlated with patients' clinical, conventional mammographic and sonographic findings. Included in the study were 41 patients. The MRI consisted of T2-weighted turbo spin-echo (TSE) sequences and dynamic measurements pre- and postcontrast using T1-weighted gradient-echo (GE) sequence. The following factors were evaluated: recognition of the flap; evidence of edema; skin thickening; and focally increased contrast medium uptake. Contrast medium dynamics were documented in instances of increased focal uptake. Flaps could be distinguished from surrounding residual breast tissue in all cases. Edema and skin thickening in the residual mammary tissue and flap implant were observed in 72.7% of patients undergoing radiation, but in only 15.8% of those not undergoing radiotherapy. The MRI excluded disease recurrence in 4 patients with suspicious mammographic and/or sonographic findings. One instance of multifocal disease recurrence identified at MRI evaded detection with all other imaging techniques used. The MRI returned false-positive findings in three cases. Because of their configuration and contrast medium uptake dynamics and their location immediately adjacent to the contact zone between the flap implant and residual mammary tissue, these findings were impossible to differentiate from a recurrent carcinoma. The MRI of the breast is generally suitable for follow-up examination of autogenous tissue reconstructions. Problems may be encountered in the evaluation of the contact zone between local adipose tissue and the flap leading to false-positive results.