THE ROLE OF DIFFERENT IMAGING MODALITIES IN POST-OPERATIVE FOLLOW UP OF BREAST CANCER

Abstract

Breast cancer is among the most common diseases affecting women worldwide, carrying a high mortality rate. Early detection and treatment may increase survival and improve quality of life which is why diagnostic accuracy is critical. Breast cancers can be divided into two main overarching groups: the carcinomas and the sarcomas. Carcinomas are cancers that arise from the epithelial component of the breast. Sarcomas are rare cancers that arise from the stromal (connective tissue) components of the breast. Sarcomas account for less than 1% of primary breast cancers. The American Joint Committee on Cancer (AJCC) staging system for breast cancer (7th edition) provides a tumor-node-metastasis (TNM) classification scheme for breast cancer that is important for determining prognosis and treat¬ment. Ascertaining the correct stage of breast cancer can be chal-lenging, and the importance of the radiologist’s role has increased over the years Radiologic information that may alter stage, prognosis, or treatment includes tumor size; number of tumor lesions; total span of disease; regional nodal status; locoregional invasion; and distant metastases to bone, lung, brain, and liver, among other anatomic structures. The earlier breast cancer is found, the better the chances that treatment will work. Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread outside the breast. But screening exams can often find breast cancers when they are small and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the outlook (prognosis) of a woman with this disease. Breast cancer is the most frequently occurring cancer in women. It is important to monitor patients with breast cancer after primary treatment to detect locoregional recurrence and distant metastasis. Locoregional recurrence is associated with an increased risk of distant disease or death in patients treated by mastectomy or lumpectomy. Many new therapies are available for patients with recurrent breast cancer, which makes earlier detection and treatment essential. American Cancer Society recommendations for the early detec¬tion of breast cancer vary depending on a woman’s age and include mammography, as well as magnetic resonance imaging (MRI) for women at high risk. In 2015, the Society updated its breast cancer screening guideline for average-risk women, and the most recent guideline for MRI use for high-risk women was released in 2007 . Conventional imaging (CI) such as mammography, breast ultrasonography, whole-body bone scintigraphy, and chest radiography is currently used for early detection of recurrence. During postsurgical evaluation of the breast by mammography or ultrasonography, it is sometimes difficult to differentiate recurrence from postoperative changes. Occult distant metastasis can also be missed, even with computed tomography (CT) and magnetic resonance imaging (MRI), because detection with CI methods is based on the presence of morphological changes. The 5-year survival rate of breast cancer has increased from 83.2% to 91.3% over the last 10 years due to advances in postoperative treatment modalities. Considering these risks, a well-designed, evidence-based post-treatment surveillance protocol is needed to manage patients with breast cancer after their primary treatment. Ultrasonography (US), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) have been utilized in many institutions to increase detection of second cancers at an early stage .