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Mammographic Findings after Breast Conservation Therapy¹

¹ From the Division of Diagnostic Imaging, Box 57, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 24, 1999; revision requested March 24 and received April 27; accepted April 28. Address reprint requests to G.J.W.

View larger version (143K): [in a new window]   Figure 1.   Preparation for radiation therapy. Photograph shows a breast that has been marked for radiation therapy. The metal bar (arrow) marks the upper edge of the radiation field. (Courtesy of Eric A. Strom, MD, University of Texas M.D. Anderson Cancer Center, Houston, Tex.)

View larger version (111K): [in a new window]   Figure 2.   Graph depicts the frequency of characteristic mammographic findings in 6- and 12-month intervals after breast conservation therapy. (Adapted, with permission, from reference 6.)

View larger version (79K): [in a new window]   Figures 3, 4.   (3) Postoperative seroma. (a) Mediolateral oblique view shows a large, dense round mass (arrow) in the upper right breast. (b) Sonogram of the upper outer right breast shows a large fluid collection with septations (arrowheads). (4) Layering of air and fluid. Magnified mediolateral view demonstrates an air-fluid level (arrow).

View larger version (100K): [in a new window]   Figures 3, 4.   (3) Postoperative seroma. (a) Mediolateral oblique view shows a large, dense round mass (arrow) in the upper right breast. (b) Sonogram of the upper outer right breast shows a large fluid collection with septations (arrowheads). (4) Layering of air and fluid. Magnified mediolateral view demonstrates an air-fluid level (arrow).

View larger version (98K): [in a new window]   Figures 3, 4.   (3) Postoperative seroma. (a) Mediolateral oblique view shows a large, dense round mass (arrow) in the upper right breast. (b) Sonogram of the upper outer right breast shows a large fluid collection with septations (arrowheads). (4) Layering of air and fluid. Magnified mediolateral view demonstrates an air-fluid level (arrow).

View larger version (85K): [in a new window]   Figure 5a.   Scar diminishing over time. (a) Mediolateral oblique view from 1995 shows scar (arrowheads) and skin thickening. (b) Mediolateral oblique view from 1998 shows contraction and shrinkage of the scar. (c) Magnified lateral medial view demonstrates fat (arrow) entrapped within the scar and skin thickening (arrowheads).

View larger version (83K): [in a new window]   Figure 5b.   Scar diminishing over time. (a) Mediolateral oblique view from 1995 shows scar (arrowheads) and skin thickening. (b) Mediolateral oblique view from 1998 shows contraction and shrinkage of the scar. (c) Magnified lateral medial view demonstrates fat (arrow) entrapped within the scar and skin thickening (arrowheads).

View larger version (149K): [in a new window]   Figure 5c.   Scar diminishing over time. (a) Mediolateral oblique view from 1995 shows scar (arrowheads) and skin thickening. (b) Mediolateral oblique view from 1998 shows contraction and shrinkage of the scar. (c) Magnified lateral medial view demonstrates fat (arrow) entrapped within the scar and skin thickening (arrowheads).

View larger version (90K): [in a new window]   Figure 6a.   Increased breast density due to edema. (a) Mediolateral oblique view shows diffuse increased density secondary to radiation-induced edema. (b) Mediolateral oblique view obtained 1 year later shows decreased density, consistent with resolving edema.

View larger version (97K): [in a new window]   Figure 6b.   Increased breast density due to edema. (a) Mediolateral oblique view shows diffuse increased density secondary to radiation-induced edema. (b) Mediolateral oblique view obtained 1 year later shows decreased density, consistent with resolving edema.

View larger version (143K): [in a new window]   Figure 7.   Skin thickening. Magnified craniocaudal view demonstrates skin thickening (arrows).

View larger version (98K): [in a new window]   Figure 8a.   Architectural distortion at the surgical site. (a) Lateral medial view shows increased density at the surgical site (arrows). (b) Magnified laterally exaggerated craniocaudal view demonstrates architectural distortion with fat entrapment (curved arrows) at the surgical site. Faint rim calcifications (straight arrow) outline the entrapped fat.

View larger version (112K): [in a new window]   Figure 8b.   Architectural distortion at the surgical site. (a) Lateral medial view shows increased density at the surgical site (arrows). (b) Magnified laterally exaggerated craniocaudal view demonstrates architectural distortion with fat entrapment (curved arrows) at the surgical site. Faint rim calcifications (straight arrow) outline the entrapped fat.

View larger version (104K): [in a new window]   Figure 9a.   Postoperative architectural distortion. (a) Left medial lateral view demonstrates increased density (arrows) in the anterior breast. (b) Left mediolateral oblique view shows a changed appearance, suggestive of architectural distortion rather than a mass.

View larger version (102K): [in a new window]   Figure 9b.   Postoperative architectural distortion. (a) Left medial lateral view demonstrates increased density (arrows) in the anterior breast. (b) Left mediolateral oblique view shows a changed appearance, suggestive of architectural distortion rather than a mass.

View larger version (123K): [in a new window]   Figure 10a.   Recurrent cancer at the surgical site. (a) Left craniocaudal view shows an irregular mass with fine spiculations (arrows) at the surgical site. (b) Left medial lateral view demonstrates the mass (arrows). Analysis of the surgical specimen obtained at mastectomy revealed invasive lobular carcinoma.

View larger version (147K): [in a new window]   Figure 10b.   Recurrent cancer at the surgical site. (a) Left craniocaudal view shows an irregular mass with fine spiculations (arrows) at the surgical site. (b) Left medial lateral view demonstrates the mass (arrows). Analysis of the surgical specimen obtained at mastectomy revealed invasive lobular carcinoma.

View larger version (159K): [in a new window]   Figures 11, 12.   (11) Progressive fat necrosis at the surgical site. (a) Magnified craniocaudal view shows scattered pleomorphic calcifications (arrows) at the surgical site. (b) Magnified craniocaudal view obtained 2 years later demonstrates conglomerate, coarse calcifications, consistent with fat necrosis. (12) Fat necrosis. Magnified craniocaudal views shows eggshell calcification (arrow) at the surgical site, characteristic of fat necrosis.

View larger version (145K): [in a new window]   Figures 11, 12.   (11) Progressive fat necrosis at the surgical site. (a) Magnified craniocaudal view shows scattered pleomorphic calcifications (arrows) at the surgical site. (b) Magnified craniocaudal view obtained 2 years later demonstrates conglomerate, coarse calcifications, consistent with fat necrosis. (12) Fat necrosis. Magnified craniocaudal views shows eggshell calcification (arrow) at the surgical site, characteristic of fat necrosis.

View larger version (115K): [in a new window]   Figures 11, 12.   (11) Progressive fat necrosis at the surgical site. (a) Magnified craniocaudal view shows scattered pleomorphic calcifications (arrows) at the surgical site. (b) Magnified craniocaudal view obtained 2 years later demonstrates conglomerate, coarse calcifications, consistent with fat necrosis. (12) Fat necrosis. Magnified craniocaudal views shows eggshell calcification (arrow) at the surgical site, characteristic of fat necrosis.

View larger version (135K): [in a new window]   Figure 13.   Dystrophic calcifications. Magnified craniocaudal view shows scattered linear dystrophic calcifications (arrows) at the surgical site.

View larger version (112K): [in a new window]   Figure 14.   Suture calcifications. Medial lateral view shows scattered, curved and knotted calcifications (arrows), which represent suture calcifications.

View larger version (133K): [in a new window]   Figure 15.   Residual ductal carcinoma in situ. Magnified lateral medial view demonstrates faint calcifications and a vague mass (arrows) near the surgical site. Analysis of the biopsy specimen revealed residual ductal carcinoma in situ.