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Detecting Nonpalpable Recurrent Breast Cancer: The Role of Routine Mammographic Screening of Transverse Rectus Abdominis Myocutaneous Flap Reconstructions¹

¹ From the Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114. (J.M.L., G.S.G., E.F.H., E.A.R., R.H.M., H.A.D., R.A.H., D.B.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass. (D.G., E.D.Y.). From the 2005 RSNA Annual Meeting. Received September 17, 2007; revision requested November 15; revision received December 12; accepted January 24, 2008; final version accepted February 19. Supported in part by a GE-AUR Research Award. Address correspondence to J.M.L. (e-mail: jlee45{at}partners.org).

Purpose: To perform a retrospective cohort study to determine the rates of recall and cancer detection and then to develop a decision analytic model to evaluate the effectiveness of routine screening of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions.

Materials and Methods: This study was approved by the institutional review board, and the methods comply with HIPAA regulations. A retrospective search of the institutional mammographic results database was done to identify bilateral screening mammographic examinations obtained from January 1, 1999, through July 15, 2005. The search included the term TRAM; the recall and cancer detetion rates were then detected. Subsequently, a decision analytic model was constructed to evaluate a hypothetical cohort of women with TRAM flap reconstructions.

Results: Of 554 mammograms (265 TRAM flap reconstructions), 546 (98.6%) had negative results (Breast Imaging Reporting and Data System category 1 or 2). Eight (1.4%) had positive test results (Breast Imaging Reporting and Data System category 0, 3, 4, or 5). All suspicious lesions underwent biopsy and had benign pathologic results. No interval breast cancers were identified. The detection rate for nonpalpable recurrent breast cancer was 0% (exact 95% confidence interval: 0.0%, 1.4%). According to decision analysis, screening would help detect an estimated 12 additional recurrent cancers per 1000 women screened, providing an additional 1.6 days of life expectancy for the screened cohort. Under base-case conditions, screening of TRAM flap reconstructions is less effective than screening asymptomatic women in their 40s. Sensitivity analysis revealed that a benefit equivalent to that of screening asymptomatic women in their 40s was achievable under conditions related to estimates of screening effectiveness and cancer detection rate.

Conclusion: Routine screening mammography of TRAM flap reconstructions has a very low detection rate for nonpalpable recurrent breast cancer. Decision analysis indicates that screening such women is less effective than screening asymptomatic women in their 40s for primary breast cancer.

© RSNA, 2008