FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast in this clinical setting. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI without IV contrast in this clinical setting. MRI Breast Without and With IV Contrast There is no evidence to support the use of MRI breast without and with IV contrast as the initial imaging modality in women with palpable lump or clinically significant pain on the mastectomy side. However, MRI may help characterize malignancy once identified and has been found to be more accurate than US in delineating extent of disease, although there is a paucity of evidence-based literature [18]. Sestamibi MBI There are a few small retrospective studies evaluating the use of Tc-99m sestamibi MBI in the context of a clinically suspicious lump. For example, Usmani et al [40] looked at 41 consecutive postmastectomy patients and found a sensitivity of 89%, specificity of 92%, PPV of 96%, negative predictive value (NPV) of 80%, and accuracy of 90% with Tc-99m sestamibi MBI. This was compared to US, which had a lower sensitivity of 86%, specificity of 77%, PPV of 89%, NPV of 71%, and accuracy of 83% (P = . 001). The authors found that the combined sensitivity was 100%, specificity 77%, PPV 90%, NPV 100%, and accuracy 93%. However, there is insufficient evidence to support the use of Tc-99m sestamibi MBI as the initial imaging modality in this setting. US Breast A retrospective evaluation of 118 palpable lumps in 101 patients, 9% of whom were status postmastectomy found 13 cancers in the mastectomy bed in women with a history of cancer. US had a high NPV of 97% and a PPV of 27% [39]. Gweon et al [41] evaluated both palpable and nonpalpable US BI-RADS categorization of lesions 4a and above at the mastectomy site and found 9/20 (45%) malignancies among palpable lesions; they also found that 100% of all BI-RADS 4c and BI-RADS 5 lesions proved to be malignant.
Imaging after Mastectomy and Breast Reconstruction. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast in this clinical setting. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI without IV contrast in this clinical setting. MRI Breast Without and With IV Contrast There is no evidence to support the use of MRI breast without and with IV contrast as the initial imaging modality in women with palpable lump or clinically significant pain on the mastectomy side. However, MRI may help characterize malignancy once identified and has been found to be more accurate than US in delineating extent of disease, although there is a paucity of evidence-based literature [18]. Sestamibi MBI There are a few small retrospective studies evaluating the use of Tc-99m sestamibi MBI in the context of a clinically suspicious lump. For example, Usmani et al [40] looked at 41 consecutive postmastectomy patients and found a sensitivity of 89%, specificity of 92%, PPV of 96%, negative predictive value (NPV) of 80%, and accuracy of 90% with Tc-99m sestamibi MBI. This was compared to US, which had a lower sensitivity of 86%, specificity of 77%, PPV of 89%, NPV of 71%, and accuracy of 83% (P = . 001). The authors found that the combined sensitivity was 100%, specificity 77%, PPV 90%, NPV 100%, and accuracy 93%. However, there is insufficient evidence to support the use of Tc-99m sestamibi MBI as the initial imaging modality in this setting. US Breast A retrospective evaluation of 118 palpable lumps in 101 patients, 9% of whom were status postmastectomy found 13 cancers in the mastectomy bed in women with a history of cancer. US had a high NPV of 97% and a PPV of 27% [39]. Gweon et al [41] evaluated both palpable and nonpalpable US BI-RADS categorization of lesions 4a and above at the mastectomy site and found 9/20 (45%) malignancies among palpable lesions; they also found that 100% of all BI-RADS 4c and BI-RADS 5 lesions proved to be malignant.