From the Department of Radiology and Rogel Cancer Center, Michigan Medicine-University of Michigan, 2910G Taubman Center, SPC 5326, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
Radiology. 2018 Oct;289(1):39-48. doi: 10.1148/radiol.2018172783. Epub 2018 Aug 21.
Purpose To examine how often screening mammography depicts clinically occult malignancy in breast reconstruction with autologous myocutaneous flaps (AMFs). Materials and Methods Between January 1, 2000, and July 15, 2015, the authors retrospectively identified 515 women who had undergone mammography of 618 AMFs and who had at least 1 year of clinical follow-up. Of the 618 AMFs, 485 (78.5%) were performed after mastectomy for cancer and 133 (21.5%) were performed after prophylactic mastectomy. Medical records were used to determine the frequency, histopathologic characteristics, presentation, time to recurrence, and detection modality of malignancy. Cancer detection rate (CDR), sensitivity, specificity, positive predictive value, and false-positive biopsy rate were calculated. Results An average of 6.7 screening mammograms (range, 1-16) were obtained over 15.5 years. The frequency of local-regional recurrence (LRR) was 3.9% (20 of 515 women; 95% confidence interval [CI]: 2.2%, 5.6%); all LRRs were invasive, and none were detected in the breast mound after prophylactic mastectomy. Of the 20 women with LRR, 13 (65%) were screened annually before the diagnosis. Seven of those 13 women (54%) had clinically occult LRR, and mammography depicted five. Five of the six clinically evident recurrences (83%) were interval cancers. The median time between reconstruction and first recurrence was 4.4 years (range, 0.8-16.2 years). The CDR per AMF was 1.5 per 1000 screening mammograms (five of 3358; 95% CI: 0.18, 2.8) after mastectomy for cancer and 0 of 1000 examinations (0 of 805 mammograms; 95% CI: 0, 5) after prophylactic mastectomy. Sensitivity, specificity, positive predictive value, and false-positive biopsy rate were 42% (five of 12), 99.4% (4125 of 4151), 16% (five of 31), and 0.6% (26 of 4151), respectively. Conclusion The CDR of screening mammography (1.5 per 1000 screening mammograms) of the AMF after mastectomy for cancer is comparable to that for one native breast of an age-matched woman. Screening mammography adds little value after prophylactic mastectomy. © RSNA, 2018.
目的 探讨在自体肌皮瓣（AMF）乳房重建中，筛查性乳房 X 线摄影术显示临床隐匿性恶性肿瘤的频率。
材料与方法 2000 年 1 月 1 日至 2015 年 7 月 15 日，作者回顾性分析了 515 例接受 618 例 AMF 乳房 X 线摄影检查且至少随访 1 年的女性患者的资料。618 例 AMF 中，485 例（78.5%）为乳腺癌根治术后，133 例（21.5%）为预防性乳房切除术。通过病历确定恶性肿瘤的频率、组织病理学特征、表现、复发时间和检测方式。计算癌症检出率（CDR）、敏感度、特异度、阳性预测值和假阳性活检率。
结果 平均每位患者接受了 6.7 次（范围，1-16 次）筛查性乳房 X 线摄影术，随访时间为 15.5 年。局部区域复发（LRR）的频率为 3.9%（515 例患者中的 20 例；95%置信区间[CI]：2.2%，5.6%）；所有 LRR 均为浸润性，预防性乳房切除术后乳房隆凸部均未发现 LRR。20 例 LRR 患者中，13 例（65%）每年接受筛查。其中 13 例患者中有 7 例（54%）存在临床隐匿性 LRR，5 例通过乳房 X 线摄影术发现。6 例临床明显复发患者中有 5 例（83%）为间隔期癌症。重建后首次复发的中位时间为 4.4 年（范围，0.8-16.2 年）。乳腺癌根治术后 AMF 的 CDR 为每 1000 次筛查性乳房 X 线摄影术 1.5 例（5 例/3358 例；95%CI：0.18，2.8），预防性乳房切除术后 AMF 的 CDR 为 0/1000 次检查（0 例/805 例；95%CI：0，5）。敏感度、特异度、阳性预测值和假阳性活检率分别为 42%（12 例中的 5 例）、99.4%（4151 例中的 4125 例）、16%（31 例中的 5 例）和 0.6%（4151 例中的 26 例）。
结论 乳腺癌根治术后 AMF 的筛查性乳房 X 线摄影术（每 1000 次筛查性乳房 X 线摄影术 1.5 例）的癌症检出率与年龄匹配的女性单侧乳房的检出率相当。预防性乳房切除术之后，筛查性乳房 X 线摄影术价值有限。
©RSNA，2018.
