Natalya M. Lvoff MD, Presenter: Nothing to Disclose

Jessica Wai Ting Leung MD, Abstract Co-Author: Nothing to Disclose

Edward A. Sickles MD, Abstract Co-Author: Nothing to Disclose

R. James Brenner MD, Abstract Co-Author: Nothing to Disclose

The optimal frequency of mammographic evaluation following breast conservation surgery for cancer is undetermined. Compliance with and outcomes of our post-lumpectomy surveillance protocol were investigated.

Our post-lumpectomy protocol of the ipsilateral breast calls for semiannual (every 6 month) mammography for 5 years. This retrospective review involves such examinations performed from 1997 through 2005. Observed inter-examination intervals of 4-9 months were considered compliant with this semiannual protocol and intervals of 9-18 months were considered compliant with annual follow-up. The study endpoint was mammographically-identified ipsilateral recurrence.

The study involves 7279 mammography examinations among 1690 patients (mean 4.3 examinations per patient). There were 112 (1.5%) abnormal interpretations, 112 biopsies performed, and 78 cancers diagnosed (10.7 per 1000 examinations), resulting in a positive biopsy rate of 70%. Among the 5589 examinations with reliably determined inter-examination intervals (1690 first post-lumpectomy examinations excluded), 4825 (86.3%) were compliant with our semiannual protocol; among the 764 noncompliant examinations, 724 were considered to represent annual follow-up. There was a trend for cancers identified at semiannual surveillance to be less advanced than those identified during annual surveillance (94% vs 73% stage 0+1, p = 0.06; 77% vs 55% minimal cancer, p = 0.13). Invasive cancers identified at semiannual surveillance also tended to be smaller (11.7 mm vs 15.2 mm, p = 0.12) and more frequently node-negative (98% vs 89%, p = 0.33) than those identified during annual surveillance.

Compliance with our post-lumpectomy protocol is high and our results suggest that semiannual surveillance may detect cancers at a smaller size and less advanced stage than annual post-lumpectomy mammography. The demonstration of true clinical effectiveness will require a randomized controlled trial, but our referring clinicians have been supportive of semiannual screening.

Compliance with semiannual post-lumpectomy surveillance is high and may detect cancers at a smaller size and less advanced stage than annual post-lumpectomy mammography.

Lvoff, N, Leung, J, Sickles, E, Brenner, R, Compliance and Outcomes Analysis of Semiannual Mammographic Surveillance Following Breast Conservation Surgery for Cancer.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4426854.html