Chest wall ultrasound good alternative after mastectomy

By Amerigo Allegretto, AuntMinnie.com staff writer

May 2, 2022 -- Ultrasound of the chest wall performs well in follow-up imaging of breast cancer patients after mastectomy, according to research presented May 2 at the American Roentgen Ray Society (ARRS) meeting in New Orleans.

In two separate presentations, Dr. Ashley Bragg and Dr. Hannah Chung from the MD Anderson Cancer Center in Texas showed that ultrasound is safe, leads to few biopsies, limits downstream costs, and has a high overall diagnostic performance.

"Breast cancer treatment is truly multidisciplinary," Chung said. "We thought this topic would be relevant to all breast imaging radiologists, as well as medical oncologists who take care of our patients after breast cancer diagnosis."

When women are diagnosed with breast cancer, two treatment options are considered, mastectomy or breast conservation surgery. If mastectomy is chosen, they are given the choice of breast reconstruction or no reconstruction.

While research shows that mastectomy significantly reduces the risk of cancer recurrence by up to 95%, recurrences still exist in some women.

The research Bragg presented at ARRS 2022 focused on the features of ultrasound after screening of the chest wall.

The team looked at data from a total of 509 ultrasound exams performed in 389 asymptomatic women with a median age of 56 years. Out of the total, 504 exams came back with benign or negative findings.

The remaining five were considered suspicious, and ultrasound-guided biopsies were performed on these. Three were found to be benign while the other two were found to be recurrent invasive lobular carcinoma.

Bragg said screening ultrasound should be considered in patients with previous recurrence and a history of invasive lobular carcinoma.

"We had no malignancies detected in patients with a history of prophylactic mastectomy," she added. "None of these patients had mammography or tomosynthesis [after mastectomy]."

In the second presentation, Chung showed research she co-led that looked at the diagnostic performance of chest wall ultrasound in patients. The team wanted to find out the malignancy rate and positive predictive value, as well as review symptoms patients experienced during examination.

The group looked at data from a total of 749 diagnostic chest wall ultrasound examinations for 591 women with an average age of 55. Out of these, 87 chest wall biopsies were performed, which found 58 malignancies, representing 7.7% of the total.

Research presented by researchers at the 2022 ARRS meeting found that ultrasound of the chest wall is safe and effective for breast imaging after mastectomy
Research presented by researchers at the 2022 American Roentgen Ray Society (ARRS) meeting found that ultrasound of the chest wall is safe and effective for breast imaging after mastectomy. Here, ultrasound shows an irregular hyperechoic mass in a 71-year-old patient that turned out to be recurrent invasive lobular carcinoma.

Palpable and skin changes were symptoms found in 53 women with malignancies. Pain meanwhile was a symptom found in just two patients in the malignancy cohort, while 177 women in the benign cohort reported experiencing pain.

Chest wall ultrasound achieved high marks on diagnostic performance. This includes 91.4% sensitivity, 96% specificity, 66.7% positive predictive value, and 99.3% negative predictive value.

Chung said that if suspicious skin changes are present and ultrasound imaging is negative, a skin punch biopsy should be considered.


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