US Breast There is insufficient evidence to support the use of ultrasound (US) for screening in this setting. There is a paucity of evidence-based literature [16,18-20], with only a few small retrospective studies finding utility in screening with US in this setting. A subset of a retrospective study evaluated 67 women postmastectomy who had suspected recurrence and underwent US imaging; although some of these women were symptomatic, 7 recurrent impalpable cancers were detected only on US in the cohort [16]. This study also found 3/61 cancers detected only on mammography and not on US. A study of 1,796 US examinations in 874 asymptomatic patients (median follow-up of 37 months) found 15 clinically occult recurrences detected with US in 15 patients (cancer detection rate of 1.7% per patient and 0.8% per examination) [19]. Lee et al [20] evaluated 1,180 consecutive screening USs of the mastectomy site and the ipsilateral axillary fossa in 468 asymptomatic women and found 10 malignancies with a similar cancer detection rate of 2.1% per patient and 0.8% per screening examination. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast for screening in this clinical setting. Digital Breast Tomosynthesis Screening Although insufficient studies have been performed to assess the utility of DBT in this setting, multiple investigations have demonstrated that DBT is helpful in the screening setting of the native breast, thus decreasing recall rates and increasing cancer detection rates compared to a conventional mammographic workup [21-26]. Mammography Screening Evidence is limited, but a few retrospective studies suggest a benefit to screening women with autologous reconstruction after mastectomy for cancer in the reconstruction side. Helvie et al [27] looked at 214 consecutive screening mammograms in 113 women with TRAM flap reconstructions, 106 (94%) of which were performed after mastectomy for cancer.
Imaging after Mastectomy and Breast Reconstruction. US Breast There is insufficient evidence to support the use of ultrasound (US) for screening in this setting. There is a paucity of evidence-based literature [16,18-20], with only a few small retrospective studies finding utility in screening with US in this setting. A subset of a retrospective study evaluated 67 women postmastectomy who had suspected recurrence and underwent US imaging; although some of these women were symptomatic, 7 recurrent impalpable cancers were detected only on US in the cohort [16]. This study also found 3/61 cancers detected only on mammography and not on US. A study of 1,796 US examinations in 874 asymptomatic patients (median follow-up of 37 months) found 15 clinically occult recurrences detected with US in 15 patients (cancer detection rate of 1.7% per patient and 0.8% per examination) [19]. Lee et al [20] evaluated 1,180 consecutive screening USs of the mastectomy site and the ipsilateral axillary fossa in 468 asymptomatic women and found 10 malignancies with a similar cancer detection rate of 2.1% per patient and 0.8% per screening examination. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast for screening in this clinical setting. Digital Breast Tomosynthesis Screening Although insufficient studies have been performed to assess the utility of DBT in this setting, multiple investigations have demonstrated that DBT is helpful in the screening setting of the native breast, thus decreasing recall rates and increasing cancer detection rates compared to a conventional mammographic workup [21-26]. Mammography Screening Evidence is limited, but a few retrospective studies suggest a benefit to screening women with autologous reconstruction after mastectomy for cancer in the reconstruction side. Helvie et al [27] looked at 214 consecutive screening mammograms in 113 women with TRAM flap reconstructions, 106 (94%) of which were performed after mastectomy for cancer.