E5473. Breast Cancer Recurrence: A Yell. A Whisper. Silent.
  1. Colleen Gilliland; University of Rochester
  2. Maria Clara Lorca; University of Rochester
  3. Tatiana Tucunduva; Fleury Laboratory Sao Paulo
  4. Ariel Fisher; University of Rochester
  5. Jennifer Harvey; University of Rochester
Improvements in breast cancer screening and treatment have led to increased survival and increased risk of recurrence. The median cumulative breast cancer recurrence rate at > 10 years is 7.9%. Some recurrences present clinically, other patients are asymptomatic, and recurrence can be diagnosed at regular screening.

Educational Goals / Teaching Points
Review the diagnostic challenges of the posttreatment breast. Characterize recurrence based on modality. Review key concepts residents need to know.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MRI was used to assess chest pain in a patient 10 years after mastectomy with a suspicious correlate on targeted ultrasound. MRI demonstrated an irregular, avidly enhancing mass with angular and microlobulated margins, penetrating into the left chest wall and deep to the pericardial space. Core needle biopsy pathology resulted in recurrent mammary adenocarcinoma. Mammogram was performed to assess a palpable abnormality in a postsurgical breast. mammogram demonstrated multiple oval, equal-density masses near the postsurgical scar. Core needle biopsy pathology resulted in invasive ductal carcinoma in a patient with a history of papillary carcinoma of the breast. Screening mammogram in an asymptomatic patient obtained several years after treatment, including mastectomy and reconstruction, showed asymmetry on CC and MLO that appears spiculated and masslike on spot CC. Core needle biopsy pathology resulted in recurrent invasive ductal carcinoma. Screening mammogram several years after lumpectomy showed two round, circumscribed, equal-density masses similar in appearance to intramammary lymph nodes, new from prior mammogram. Core needle biopsy pathology resulted in recurrent multifocal invasive ductal carcinoma.

Breast cancer recurrence can be conspicuous and attention-grabbing or subtle in its clinical presentation. It can also be inconspicuous, as in an asymptomatic patient whose recurrence is picked up on regular screening. Radiologists must be familiar with the warning signs and the subtle imaging findings that may suggest breast cancer recurrence and maintain a high index of suspicion when reviewing imaging for a patient with a personal history of breast cancer.