Evidence to support the use of ultrasound in addition to mammography as part of breast cancer follow-up surveillance

Introduction

Following breast cancer treatment, our unit has routinely offered ultrasound in conjunction with mammography as part of radiological follow-up surveillance. The primary objective was to assess the value of ultrasound as an adjunct to mammography in surveillance detection of local/nodal recurrent disease.

Methods

A retrospective analysis of all breast cancer patients with recurrence who had completed 5 years of follow-up was performed. The site of recurrence was noted (local and/or nodal) and the method of detection was also recorded. The recurrences primarily detected as a result of radiological surveillance invite were investigated and noted to be apparent by mammogram exclusively, apparent by ultrasound exclusively or apparent by both modalities.

Results

During the 8-year study period, 2,580 patients were treated surgically and completed follow-up; 116 recurrences were detected (4.5%). From the 116 patients the total number of recurrences detected purely as a result of radiological surveillance invite was 43% (n = 50). Of those, 22% (n = 11) were ultrasound detectable only. The primary method of detection was very different depending on the site of recurrence.

Conclusion

Ultrasound does have value in radiological breast cancer follow-up as an adjunct to mammography, being the primary and exclusive detection tool in 1/5 of radiologically detected cases overall. Ultrasound surveillance has primarily detected 25% of nodal recurrence that otherwise would have lead to delayed diagnosis.