ARRS 2022 Abstracts


2044. Clinical Utility of Diagnostic Ultrasound of the Chest Wall in the Mastectomy Patient
Authors * Denotes Presenting Author
  1. Hannah Chung *; University of Texas MD Anderson Cancer Center
  2. Kyungmin Shin; University of Texas MD Anderson Cancer Center
  3. Megan Speer; University of Texas MD Anderson Cancer Center
  4. Ashley Bragg; University of Texas MD Anderson Cancer Center
  5. Jia Sun; University of Texas MD Anderson Cancer Center
  6. Jessica Leung; University of Texas MD Anderson Cancer Center
This study aims to assess the utility of ultrasound (US) in the diagnostic evaluation of the chest wall after mastectomy.

Materials and Methods:
This was an IRB-approved, retrospective study on US examinations of the chest wall region after mastectomy from January 2016 - January 2017. US of the chest wall includes a minimum of two orthogonal sonographic views from the clavicle superiorly to the upper abdomen inferiorly and from the sternum medially to the mid axillary line laterally. Cases of known chest wall recurrence and surveillance screening US were excluded.

During the 13-month period, there were 379 diagnostic US examinations in 337 patients with mastectomy (median 54 years, range 27-82), in whom 163 (43.0%) had reconstruction with implant, 83 (21.9%) had reconstruction with autologous flap, 14 (3.7%) had reconstruction with combined flap and implant, and 119 (31.4%) were without reconstruction. Diagnostic indications for a chest wall US were palpable lumps (n=161), pain (n=80), suspected fluid collections (n=44), skin changes (n=30), swelling (n=22), abnormal findings on another imaging examination (n=18), follow up of prior sonographic abnormality (n=11), chest wall evaluation for nodal recurrence (n=11), close surgical margins (n=1), and contour abnormality (n=1). Fifty-three chest wall biopsies were performed, with 21 benign and 32 malignant results, yielding an 8.4% (32/379) cancer detection rate with a 95% confidence interval (CI) (5.8%, 11.7%), and a 60.4% (32/53) positive biopsy rate with a 95% CI (46.0%, 73.5%). The 21 benign results consisted of fat necrosis (8), fibrosis/scar (8), lymph nodes (2), dermal cysts (2), and lipoma (1). Thirty-two chest wall malignancies presented as a palpable lump (n=18, 56.3%), abnormal finding on another imaging examination (n=8, 25.0%), skin changes (n=5,15.6%), or swelling (n=1, 3.1%) and occurred regardless of reconstruction type (15 implants, one flap, and two combined) or absence of reconstruction. Thirty chest wall malignancies were recurrences of the original breast malignancy (28 epithelial breast cancers, one metaplastic carcinoma, and one breast sarcoma) and two were new malignancies (one radiation associated sarcoma and one anaplastic large cell lymphoma).

Diagnostic US of the chest wall detects the majority (96.9%) of post-mastectomy chest wall malignancies, that present as a clinical concern (palpable lump, 56.3% or skin changes,15.6%) or as abnormal findings on other imaging examinations (25.0%). In particular, suspicious US findings of the chest wall have a high likelihood of malignancy with a positive biopsy rate of 60.4%.