Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI in this clinical scenario. Variant 4: Adult female. Postsurgical excision for breast cancer. Positive margins. Asymptomatic. Initial imaging. Margin status is an important predictor of local recurrence of invasive or in situ cancer after breast conservation surgery. For invasive breast cancer (with or without DCIS), a negative margin is defined as no tumor on ink by histology. In contrast, guidelines recommend that margins for pure DCIS (with or without microinvasion) be at least 2 mm [21]. Frequencies of positive margins after initial surgery vary based on multiple factors including type of breast cancer, appearance on imaging, breast density, and surgical technique. Positive margins at first surgery and at final breast surgery are predictors of breast cancer recurrence [23]. The goal of surgery is to remove the tumor and obtain negative margins. Re-excision is usually performed in the setting of positive margins, often without additional imaging evaluation. Imaging is sometimes used to help delineate residual disease before re-excision. Sometimes despite re-excision, margins remain close or positive. Digital Breast Tomosynthesis Diagnostic There is no relevant literature to support the routine use of diagnostic DBT in this clinical scenario. When diagnostic mammography is performed in this scenario, it is typically for evaluation of residual calcifications, which are better visualized on magnification mammograms rather than DBT. One small retrospective study evaluated postexcision mammography and MRI to assess for residual disease. Of 51 patients with malignant calcifications (32 with and 19 without residual disease), mammography sensitivity, specificity, and accuracy were 78.1%, 42.1%, and 62.7%, respectively.
Imaging after Breast Surgery. Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI in this clinical scenario. Variant 4: Adult female. Postsurgical excision for breast cancer. Positive margins. Asymptomatic. Initial imaging. Margin status is an important predictor of local recurrence of invasive or in situ cancer after breast conservation surgery. For invasive breast cancer (with or without DCIS), a negative margin is defined as no tumor on ink by histology. In contrast, guidelines recommend that margins for pure DCIS (with or without microinvasion) be at least 2 mm [21]. Frequencies of positive margins after initial surgery vary based on multiple factors including type of breast cancer, appearance on imaging, breast density, and surgical technique. Positive margins at first surgery and at final breast surgery are predictors of breast cancer recurrence [23]. The goal of surgery is to remove the tumor and obtain negative margins. Re-excision is usually performed in the setting of positive margins, often without additional imaging evaluation. Imaging is sometimes used to help delineate residual disease before re-excision. Sometimes despite re-excision, margins remain close or positive. Digital Breast Tomosynthesis Diagnostic There is no relevant literature to support the routine use of diagnostic DBT in this clinical scenario. When diagnostic mammography is performed in this scenario, it is typically for evaluation of residual calcifications, which are better visualized on magnification mammograms rather than DBT. One small retrospective study evaluated postexcision mammography and MRI to assess for residual disease. Of 51 patients with malignant calcifications (32 with and 19 without residual disease), mammography sensitivity, specificity, and accuracy were 78.1%, 42.1%, and 62.7%, respectively.