Sandra Brennan MBBCh, MSc, Presenter: Nothing to Disclose

Donna Danielle D'Alessio MD, Abstract Co-Author: Nothing to Disclose

Jennifer Brisman Kaplan MD, Abstract Co-Author: Nothing to Disclose

Marcia Edelweiss MD, Abstract Co-Author: Nothing to Disclose

Alexandra Heerdt, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Morris MD, Abstract Co-Author: Nothing to Disclose

To determine the positive predictive value (PPV) of biopsy of palpable masses on the mastectomy (MX) side and to determine if there are patient or imaging features predictive of cancer.

Following IRB approval, we performed a HIPPA-compliant retrospective review of 3,286 breast ultrasounds (US) performed from June 2008 to January 2013 to identify patients with MX presenting with palpable masses on the MX side. We included reconstructed and non-reconstructed breasts and both prophylactic and therapeutic MX. Medical records and imaging studies were reviewed. Statistical analysis was performed with Fisher’s exact test. 95% confidence intervals (CI) were calculated.

69 patients with MX had targeted US of palpable masses. Age 25-82, mean 52 years. 43/69 (62%) underwent biopsy. 26/69 (38%) had follow-up and no biopsy; range of follow-up was 4-71, mean 21 months. 53/69 patients had a mass on US. 16/69 had no mass and the palpable was related to the implant in 7, clip/suture in 4, rib 1 and 4 had no finding on US. 12/43 (28%, 95% CI; 17-43) who underwent biopsy had cancer (age 35-68, mean 49 years), 31/43 (72%) were benign. All 12 cancers were on the original cancer side not the prophylactic MX side. 5/12 (42%) had received prior radiation and 6/12 (50%) hormonal therapy. Recurrences ranged from 0.6 to 4.5 cm maximum diameter, mean 1.6cm. Neither patient age (p=1.0), hormonal (p=0.14) or radiation therapy (p=0.7) had a statistically significant association with finding cancer on biopsy. Lesion shape (irregular versus oval/round) was very statistically significant (p=0.003) as was non-parallel orientation on US (P=0.01). Circumscribed versus non-circumscribed margins was not quite statistically significant (p=0.08). Lesion size and presence of shadowing were not statistically significant (p=1.0). No cancers were found on follow-up.  

The PPV of biopsy of palpable masses on the MX side in our study was 28% (95% CI; 17-43). Neither patient age, prior history of radiation or hormonal therapy had a statistically significant association with positive biopsy. All recurrences were on the original cancer side. An irregular shape and anti-parallel orientation on US were significantly associated with cancer.

The PPV of biopsy of palpable masses on the MX side is high at 28% with irregular shape and anti-parallel orientation on US significantly associated with cancer.

Brennan, S, D'Alessio, D, Kaplan, J, Edelweiss, M, Heerdt, A, Morris, E, Positive Predictive Value of Biopsy of Palpable Masses on the Mastectomy Side in Reconstructed and Non-reconstructed Breasts.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015799.html