Abstract
Background
In women with breast cancer and calcifications, controversy exists over the need for postexcision/lumpectomy, preradiation mammogram (PEM) after breast-conserving surgery (BCS). Further, the need for excision of remaining or suspicious calcifications after PEM when surgical margins are negative is unclear. We sought to characterize the utility of PEM hypothesizing that its value in directing the need for additional surgery is minimized after achieving negative surgical margins.
Methods
We identified 524 women with breast cancer and calcifications treated with BCS with negative margins between 1996 and 2011.
Results
PEM was performed in 112 of 524 (21 %) women, with residual calcifications identified in 10 of 112 (9 %); of these, 2 of 112 (1.8 %) had residual disease. Local recurrence occurred in 4 of 112 (4 %) patients, none of whom had residual calcifications identified on PEM. The remaining 412 of 524 (79 %) women did not have PEM but had a postradiation mammogram 6 to 12 months after treatment identifying calcifications in 19 (5 %) women. Tissue diagnosis was benign in 14 women and was not pursued in the remaining 5. Local recurrence occurred in 13 (3 %) patients, none of whom had calcifications on the new post radiation baseline mammogram.
Conclusions
Mammographically apparent calcifications representing residual disease occur infrequently after BCS with negative margins. The value of PEM may be to document the new radiographic baseline but should not be required to ensure adequate surgery. Radiation plays an integral role in sterilization of the remaining breast tissue after BCS.
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References
Aref A, Youssef E, Washington T, Segel M, Grigorian C, Bongers S et al. The value of postlumpectomy mammogram in the management of breast cancer patients presenting with suspicious microcalcifications. Cancer J Sci Am. 2000;6:25–7.
Dershaw D. Mammography in patients with breast cancer treated by breast conservation (lumpectomy with or without radiation). AJR Am J Roentgenol. 1995;164:309–16.
Dershaw DD. Evaluation of the breast undergoing lumpectomy and radiation therapy. Radiol Clin North Am. 1995;33:1147–60.
Winchester D, Strom E. Standards for diagnosis and management of ductal carcinoma in situ (DCIS) of the breast—American College of Radiology—American College of Surgeons—College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin. 1998;48:108–28.
Grann A, Abdou C, Dragman N, Goodman R. The value of postexcision preradiation mammography in patients with early-stage breast cancer. Am J Clin Oncol. 2004;27:285–8.
Lin K, Eradat J, Mehta N, Bent C, Lee S, Apple S et al. Is a short-interval postradiation mammogram necessary after conservative surgery and radiation in breast cancer? Int J Radiat Oncol Biol Phys. 2008;72:1041–7.
Katipamula R, Degnim A, Hoskin T, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–8.
Habermann E, Abbott A, Parsons H, Virnig B, Al-Refaie W, Tuttle T. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010;28:3437–41.
Adkisson C, Bagaria S, Parker A, et al. Which eligible breast conservation patients choose mastectomy in the setting of newly diagnosed breast cancer? Ann Surg Oncol. 2012;19:1129–36.
Khatcheressian J, Hurley P, Bantug E, et al. Breast cancer follow–up and management after primary treatment: american society of clinical oncology clinical practice guideline update. J Clin Oncol. 2012;30:1–6.
NCCN clinical practice guidelines in oncology (NCCN Guidelines). Breast Cancer. Version 3.2013. 2013;National Comprehensive Cancer Network.
Hasselgren P, Hummel R, Georgian-Smith D, Fieler M. Breast biopsy with needle localization: accuracy of specimen x-ray and management of missed lesions. Surgery. 1993;114:836–40.
Waddell B, Stomper P, DeFazio J, Hurd T, Edge S. Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast. Ann Surg Oncol. 2000;7:665–8.
Teixidor H, Chu F, Kim Y, Levin T. The value of mammography after limited breast surgery and before definitive radiation therapy. Cancer. 1992;69:1418–23.
Gluck B, Dershaw D, Liberman L, Deutch B. Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision. Radiology. 1993;188:469–72.
Holland R, Veling S, Mravunac M, et al. Histologic multifocality of tis, T1-2 breast carcinomas implications for clinical trials of breast-conserving surgery. Cancer. 1985;56(5):979–90.
Dunne C, Burke J, Morrow M, Kell M. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009;27:1615–20.
Rudloff U, Brogi E, Reiner A, et al. The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy. Ann Surg. 2010;251:583–91.
Silverstein M, Lagios M, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med. 1999;340:1455–61.
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Adkisson, C.D., McLaughlin, S.A., Vallow, L.A. et al. Is Postexcision, Preradiation Mammogram Necessary in Patients After Breast-Conserving Surgery with Negative Margins. Ann Surg Oncol 20, 3205–3211 (2013). https://doi.org/10.1245/s10434-013-3148-6
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DOI: https://doi.org/10.1245/s10434-013-3148-6