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, ultrasonogr aphy or fine needle aspiration cytology was 69.8, 66.1, 73.3 and 77.8 %, respectively. The sensitivity was not significantly influenced by p revious radiotherapy, type of recurrence (new primary or true recurren ce), 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 fol lowing diagnostic evaluation resulted in 34 unnecessary benign biopsie s, giving a positive predictive value for biopsy of 86.8 %. Of 171 rec urrences undergoing a triple diagnostic approach (palpation, mammograp hy/ultrasonography, cytology), recurrence was suspected by at least on e, two or three tests in 99.3, 81.8 or 40.3 % of cases, respectively. A multimodal diagnostic approach is necessary to maximize the sensitiv ity of detecting breast cancer recurrence after conservation therapy, and should be employed routinely.