E2744. Evaluation of Tumor Recurrence After Mastectomy: Diagnostic Algorithm and Imaging Review
  1. Janice Thai; Massachusettes General Hospital
Postmastectomy/reconstruction patients represent a unique patient population in diagnostic breast imaging. Tumor recurrence after mastectomy is often detected by palpation on physical examination. Diagnostic imaging maintains its critical role in confirmation of disease recurrence. The purpose of this exhibit is to review the spectrum of normal and abnormal findings on diagnostic imaging work-up of patients presenting with a palpable concern after mastectomy, with or without breast reconstruction.

Educational Goals / Teaching Points
Recognition of a wide spectrum of normal and abnormal findings in multimodality imaging is critical in detection and workup of suspected tumor recurrence. The diagnostic imaging algorithm for the evaluation of postmastectomy patients will be presented. The spectrum of normal and abnormal findings on mammography, ultrasound, and MRI in the postoperative/reconstructed breast will be reviewed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Palpable abnormalities often manifest as irregular masses on imaging. The differential diagnosis for irregular masses in postmastectomy patients includes malignancy and benign mimics encompassing the spectrum of normal postoperative findings such as scar, fibrosis, fat necrosis and other expected postoperative changes in the breast. The wide spectrum of multimodality imaging features will be reviewed with case-based discussions. In patients with breast reconstruction, an imaging review will be provided for normal and abnormal imaging findings in patients with implants or autologous tissue flap reconstruction (TRAM, DIEP, SIEP, LAT and beyond).

Recognition of a wide imaging spectrum in postmastectomy patients will aid in expedient diagnosis of tumor recurrence. Understanding the diagnostic algorithm for evaluation of this unique patient population ensures proper management.