The cancer detection rate was 0.9% per screen and 1.9% per patient (2/106, 95% confidence interval [CI]: 0.33%, 7.32%) and positive predictive value (PPV) of biopsy was 33% (95% CI: 6%, 76%). Noroozian et al [10] in a larger study of 515 women and 618 mastectomies with reconstruction, 485 of which were performed for cancer, found the cancer detection rate of screening mammography to be 1.5/1,000 screening mammograms, comparable to that for one native breast of age-matched women. However, Freyvogel et al [28] retrospectively evaluated 541 postmastectomy and autologous reconstruction patients. Of these, 397 patients had screening mammography and 537 patients underwent routine clinical examination. Of the patients in the cohort, 26 of 27 (96.3%) had a clinically detectable recurrence, and the two cancers detected on screening were also palpable on follow-up clinical examination. Lee et al [29] evaluated 554 mammograms (265 TRAM flap reconstructions); no cancers were detected through screening and no interval nonpalpable recurrent breast cancers missed at mammography were identified, yielding a 0% rate of detection (exact 95% CI: 0.0%, 1.4%). The authors concluded that screening this population is less effective than screening average-risk women in their 40s, although it should be noted that the upper end of the CI is in line with the rates reported by the other studies mentioned above. Of note, there are no studies specifically evaluating decrease in mortality from screening women in this setting. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI of the breast without IV contrast for screening in this clinical setting. MRI Breast Without and With IV Contrast There is insufficient evidence to support the use of MRI without and with IV contrast for screening in this setting.
Imaging after Mastectomy and Breast Reconstruction. The cancer detection rate was 0.9% per screen and 1.9% per patient (2/106, 95% confidence interval [CI]: 0.33%, 7.32%) and positive predictive value (PPV) of biopsy was 33% (95% CI: 6%, 76%). Noroozian et al [10] in a larger study of 515 women and 618 mastectomies with reconstruction, 485 of which were performed for cancer, found the cancer detection rate of screening mammography to be 1.5/1,000 screening mammograms, comparable to that for one native breast of age-matched women. However, Freyvogel et al [28] retrospectively evaluated 541 postmastectomy and autologous reconstruction patients. Of these, 397 patients had screening mammography and 537 patients underwent routine clinical examination. Of the patients in the cohort, 26 of 27 (96.3%) had a clinically detectable recurrence, and the two cancers detected on screening were also palpable on follow-up clinical examination. Lee et al [29] evaluated 554 mammograms (265 TRAM flap reconstructions); no cancers were detected through screening and no interval nonpalpable recurrent breast cancers missed at mammography were identified, yielding a 0% rate of detection (exact 95% CI: 0.0%, 1.4%). The authors concluded that screening this population is less effective than screening average-risk women in their 40s, although it should be noted that the upper end of the CI is in line with the rates reported by the other studies mentioned above. Of note, there are no studies specifically evaluating decrease in mortality from screening women in this setting. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI of the breast without IV contrast for screening in this clinical setting. MRI Breast Without and With IV Contrast There is insufficient evidence to support the use of MRI without and with IV contrast for screening in this setting.