Diagnostic features of 225 consecutive cases of cancer recurrence in the conserved breast

The diagnostic features of 225 consecutive cases of cancer recurrence (186 true recurrences, 39 new primary cancers) in the conserved breast were reviewed. The sensitivity of palpation, mammography, ultrasonography or fine needle aspiration cytology was 69.8, 66.1, 73.3 and 77.8%, respectively. The sensitivity was not significantly influenced by previous radiotherapy, type of recurrence (new primary or true recurrence), or patient age. Although the sensitivity of mammography was lower (60.6 vs 69.3%) in the presence of dense compared with fatty breasts, this did not explain most of the mammographic false negatives, some of which were likely to be due to the masking effect of surgical scar and distortion. In the study period suspicion of breast recurrence following diagnostic evaluation resulted in 34 unnecessary benign biopsies, giving a positive predictive value for biopsy of 86.8%. Of 171 recurrences undergoing a triple diagnostic approach (palpation, mammography/ultrasonography, cytology), recurrence was suspected by at least one, two or three tests in 99.3, 81.8 or 40.3% of cases, respectively. A multimodal diagnostic approach is necessary to maximize the sensitivity of detecting breast cancer recurrence after conservation therapy, and should be employed routinely.