DOI: 10.1148/rg.242035072
RadioGraphics 2004;24:357-365
© RSNA, 2004
Normal and Abnormal US Findings at the Mastectomy Site1
Sun Mi Kim, MD and
Jeong Mi Park, MD
1 From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Pungnap-dong, Songpa-gu, Seoul 138–736, Korea. Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received March 17, 2003; revision requested May 7 and received June 26; accepted June 27. Both authors have no financial relationships to disclose. Address correspondence to J.M.P., Department of Radiology, University of Wisconsin Hospital and Clinics G3/120, 600 Highland Ave, Madison, WI 53792-1840 (e-mail: jmpark@mail.radiology.wisc.edu).
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Abstract
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Evaluation of a mastectomy site is more effective with ultrasonography (US) than with either mammography or chest computed tomography because abnormalities are usually small and close to the skin surface. US does not involve the use of ionizing radiation and has a multiplanar scanning capability. The technique is readily available and inexpensive, and it allows real-time monitoring of needle tip placement during biopsy of a lesion. Normal US anatomy of the chest wall after mastectomy usually consists of four layers: skin, subcutaneous fat, pectoral muscles, and rib and intercostal muscle. The axilla is changed in appearance after lymph node dissection, but it remains the same in patients who have undergone simple mastectomy. US can accurately depict benign and malignant conditions in the mastectomy site, including fluid collection, fibrosis, local recurrent tumor, and metastatic lymphadenopathy, and can enable accurate diagnosis based on findings at fine needle aspiration biopsy.
© RSNA, 2004
Index Terms: Breast, postoperative, 00.45 • Breast, surgery, 00.45 • Breast, US, 00.1298 • Breast neoplasms, 00.32 • Breast neoplasms, surgery, 00.45 Breast neoplasms, US, 00.1298
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LEARNING OBJECTIVES
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After reading this article and taking the test, the reader will be able to:
- Describe the normal US anatomy of a mastectomy site.
- Identify benign US abnormalities at a mastectomy site.
- Recognize malignant US features at a mastectomy site.
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Introduction
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Imaging modalities have not been widely used for examining mastectomy sites, because recurrent tumors that involve the chest wall or skin are frequently detected at clinical examination. However, because of the thick subcutaneous tissue, it is not always easy to differentiate between benign and malignant lesions on the basis of clinical examination alone. Mammography has technical limitations and therefore seldom provides additional information. The sensitivity of mammography for detection of recurrent cancer is inferior to the sensitivities of clinical examination and of ultrasonography (US) (1). The sensitivity of US for detection of local recurrence is superior to the sensitivities of palpation and mammography (1). US does not involve the use of ionizing radiation and has multiplanar scanning capability. The technique is readily available and inexpensive, and it allows real-time monitoring of needle tip placement during fine needle aspiration biopsy of a lesion. This article describes the normal US anatomy of a mastectomy site and illustrates the imaging and pathologic features of various benign and malignant conditions that may be seen with US at mastectomy sites.
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Normal US Anatomy of a Mastectomy Site
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The postoperative appearance of the chest wall varies according to the mastectomy method. The US anatomy of the chest wall after mastectomy usually consists of four layers: skin, subcutaneous fat, the pectoral muscles, and the rib and intercostal muscle. The skin appears on US images as a thin hyperechoic layer. The normal range of skin thickness is 0.5–2.0 mm. Subcutaneous fat is an isoechoic layer. Its thickness varies according to the patient’s body habitus. The pectoral muscle appears as an echogenic layer because of the multiple horizontal fanlike linear reflections of the fascial planes. Costal cartilage is homogeneous and less echogenic than the adjacent muscle. It appears round or ovoid on a sagittal image and tubular on a transverse image (Fig 1a, 1b) (2). Acoustic shadowing posterior to the ribs and sternum helps to differentiate these structures from costal cartilage (Fig 1a). The internal mammary vessels pass deep into the costal cartilage (Fig 1c). The axilla is changed because of lymph node dissection, except in cases of simple mastectomy. When metastatic lymphadenopathy is suspected, parasternal and supraclavicular areas also must be investigated. The normal anatomy of the chest wall (Fig 1a, 1b), axilla (Fig 1d), and parasternal (Fig 1c) and supraclavicular (Fig 1e) areas after mastectomy is shown in Figure 1.
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Figure 1a. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.
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Figure 1b. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.
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Figure 1c. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.
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Figure 1d. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.
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Figure 1e. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.
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Benign Conditions
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Fluid Collection
Hematoma and seroma are well-known possible sequelae of mastectomy and typically develop early in the postsurgical period. US is valuable for differentiating a fluid-filled structure from a solid structure at the surgical site (Fig 2) (3). In addition, US is useful for guiding and monitoring needle placement for fluid aspiration during biopsy (4).
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Figure 2a. Seroma in a 51-year-old woman who presented with redness and a palpable lesion at the mastectomy site 7 months after modified radical mastectomy of the left breast. Transverse US images of the chest wall show partial views (a, medial part; b, lateral part) of a septated cystic lesion (arrows) in association with a slight thickening of the skin at the mastectomy site. The diagnosis was seroma with cellulitis or edema.
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Figure 2b. Seroma in a 51-year-old woman who presented with redness and a palpable lesion at the mastectomy site 7 months after modified radical mastectomy of the left breast. Transverse US images of the chest wall show partial views (a, medial part; b, lateral part) of a septated cystic lesion (arrows) in association with a slight thickening of the skin at the mastectomy site. The diagnosis was seroma with cellulitis or edema.
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Postoperative Fibrosis
On US images, postoperative fibrosis may appear as an irregular hypoechoic lesion with posterior acoustic shadowing and cannot be distinguished from cancer. Findings of stability or regression (including slow retraction over a long period of time) in a lesion localized in the surgical bed may indicate fibrosis (Fig 3) (3).
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Figure 3a. Postoperative fibrosis in a 37-year-old woman who had undergone left modified radical mastectomy 6 months prior to US evaluation for a newly developed nodule found on a contralateral mammogram. Transverse (a) and sagittal (b) US images of the axilla show a well-defined irregular hypoechoic lesion (arrows) at the site of previous axillary node dissection. This lesion changed shape when compressed, a finding inconsistent with malignancy.
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Figure 3b. Postoperative fibrosis in a 37-year-old woman who had undergone left modified radical mastectomy 6 months prior to US evaluation for a newly developed nodule found on a contralateral mammogram. Transverse (a) and sagittal (b) US images of the axilla show a well-defined irregular hypoechoic lesion (arrows) at the site of previous axillary node dissection. This lesion changed shape when compressed, a finding inconsistent with malignancy.
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Malignant Conditions
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Local Recurrence
Modified radical mastectomy is one of the treatment methods for local or regional breast cancer. The reported failure rate of this treatment method varies from less than 5% to greater than 30% (5). There are two main hypotheses regarding the origins and significance of local-regional recurrences of breast cancer. The first is that such recurrences are caused by incomplete local removal of the tumor; the other is that they are early signs of disseminated disease (6). Recommendations for treatment of local-regional recurrences vary widely but frequently include surgical resection, external radiation therapy, systemic hormone therapy, or chemotherapy (5).
In patients who have undergone mastectomy, axillary node dissection, and adjuvant chemotherapy, the most common sites of local breast cancer recurrence are the chest wall (Figs 4, 5) and the supraclavicular nodes (Fig 6) (7). Chest wall invasion may occur either by direct local extension of the tumor through the pectoral fascia and into the pectoral muscles or by indirect extension via interpectoral nodes (Rotter nodes) (Fig 7) (8). Most recurrent cancers appear on US images as hypoechoic lesions (1) (Figs 4, 5, 7). In 10% of hypoechoic lesions, the anteroposterior diameter is greater than the transverse diameter (1). Accurate diagnosis may be achieved with US-guided fine needle aspiration biopsy even in a shallowly located or small lesion (Fig 4). Another possible site of tumor recurrence is the undissected lymphatics. The cumulative probability of treatment failure in the subclavicular region ranges from 10% to 35% in patients treated for local recurrence (9). Metastases in unexcised Rotter lymph nodes without axillary node disease may become a more significant source of local or systemic treatment failure (Figs 7, 8). After standard axillary clearance (at least at levels I and II), failure in the axillary nodes occurs in approximately 10% of patients with local recurrence (9). Metastasis to the internal mammary and axillary nodes usually occurs synchronously; however, metastasis is infrequently (in 4%–6% of cases) isolated in the internal mammary chain (Fig 9) (8). US examination of metastatic disease in the supraclavicular fossae, interpectoral region, or parasternal area may reveal relatively hypoechoic, solid, smooth-marginated masses consistent with enlarged lymph nodes. No central zone of hyperechogenicity (consistent with the lymph node hilum) is detected in the relatively hypoechoic homogeneous mass (10). Most metastatic nodes show thickened cortex and loss of hilum or flattened hilum (Figs 6–9). In the presence of extranodal extension, the node has an irregular rather than ovoid shape (Fig 7). A diagnosis of metastatic lymph node disease with reactive hyperplasia may be confirmed with US-guided fine needle aspiration biopsy.
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Figure 4a. Recurrent ductal carcinoma in a 54-year-old woman who had undergone left modified radical mastectomy 5 years prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The radiologic diagnosis was confirmed at biopsy. (b) Transverse image from real-time US monitoring at fine needle aspiration biopsy shows the needle tip (arrowheads) during placement in the lesion (arrows).
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Figure 4b. Recurrent ductal carcinoma in a 54-year-old woman who had undergone left modified radical mastectomy 5 years prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The radiologic diagnosis was confirmed at biopsy. (b) Transverse image from real-time US monitoring at fine needle aspiration biopsy shows the needle tip (arrowheads) during placement in the lesion (arrows).
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Figure 5a. Recurrent ductal carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 15 months prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The diagnosis was confirmed with US-guided fine needle aspiration biopsy. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma (arrows) in the fat tissue.
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Figure 5b. Recurrent ductal carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 15 months prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The diagnosis was confirmed with US-guided fine needle aspiration biopsy. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma (arrows) in the fat tissue.
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Figure 6a. Recurrent carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 44 months prior to US for a palpable lesion in the left supraclavicular area. (a, b) Transverse (a) and sagittal (b) US images show well-defined ovoid hypoechoic nodules (arrows) in the left supraclavicular area. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows enlarged lymph nodes with a malignant cellular infiltrate (arrows).
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Figure 6b. Recurrent carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 44 months prior to US for a palpable lesion in the left supraclavicular area. (a, b) Transverse (a) and sagittal (b) US images show well-defined ovoid hypoechoic nodules (arrows) in the left supraclavicular area. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows enlarged lymph nodes with a malignant cellular infiltrate (arrows).
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Figure 6c. Recurrent carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 44 months prior to US for a palpable lesion in the left supraclavicular area. (a, b) Transverse (a) and sagittal (b) US images show well-defined ovoid hypoechoic nodules (arrows) in the left supraclavicular area. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows enlarged lymph nodes with a malignant cellular infiltrate (arrows).
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Figure 7a. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.
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Figure 7b. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.
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Figure 7c. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.
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Figure 7d. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.
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Figure 7e. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.
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Figure 7f. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.
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Figure 8a. Metastatic carcinoma of the interpectoral lymph node in a 55-year-old woman 4 years after left modified radical mastectomy. Transverse (a) and sagittal (b) US images of the chest wall show a well-defined ovoid hypoechoic nodule (arrows) in the interpectoral area. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy and excision biopsy.
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Figure 8b. Metastatic carcinoma of the interpectoral lymph node in a 55-year-old woman 4 years after left modified radical mastectomy. Transverse (a) and sagittal (b) US images of the chest wall show a well-defined ovoid hypoechoic nodule (arrows) in the interpectoral area. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy and excision biopsy.
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Figure 9a. Metastatic lymphadenopathy in the left supraclavicular area in a 44-year-old woman who had undergone left modified radical mastectomy 1 year prior to US. (a, b) Transverse (a) and sagittal (b) US images show a well-defined ovoid hypoechoic nodule (arrows) in the left parasternal area. (c) Transverse CT image shows enlarged lymph nodes (arrows) in the left internal mammary chain.
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Figure 9b. Metastatic lymphadenopathy in the left supraclavicular area in a 44-year-old woman who had undergone left modified radical mastectomy 1 year prior to US. (a, b) Transverse (a) and sagittal (b) US images show a well-defined ovoid hypoechoic nodule (arrows) in the left parasternal area. (c) Transverse CT image shows enlarged lymph nodes (arrows) in the left internal mammary chain.
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Figure 9c. Metastatic lymphadenopathy in the left supraclavicular area in a 44-year-old woman who had undergone left modified radical mastectomy 1 year prior to US. (a, b) Transverse (a) and sagittal (b) US images show a well-defined ovoid hypoechoic nodule (arrows) in the left parasternal area. (c) Transverse CT image shows enlarged lymph nodes (arrows) in the left internal mammary chain.
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Rib Metastasis
The skeleton is the most common site of distant metastases in patients treated with mastectomy and adjuvant chemotherapy (8). Although bone scintigraphy and positron emission tomography with fludeoxyglucose, or FDG PET, are more sensitive than US for detecting bone metastasis and although US is not usually used to study bone lesions, it is possible to obtain accurate US images of osteolytic metastatic rib lesions in which the cortical bone structure has been completely destroyed (Fig 10).
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Figure 10a. Bone metastases in a 36-year-old woman who had undergone right modified radical mastectomy 1 year prior to US for a palpable lesion in the left breast. (a, b) Transverse (a) and sagittal (b) US images show an ill-defined irregular heterogeneous hypoechoic mass with a disrupted margin (arrows) in a rib. (c) Bone scintigram shows multiple areas of radionuclide uptake in the ribs and spine, findings suggestive of diffuse bone metastases.
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Figure 10b. Bone metastases in a 36-year-old woman who had undergone right modified radical mastectomy 1 year prior to US for a palpable lesion in the left breast. (a, b) Transverse (a) and sagittal (b) US images show an ill-defined irregular heterogeneous hypoechoic mass with a disrupted margin (arrows) in a rib. (c) Bone scintigram shows multiple areas of radionuclide uptake in the ribs and spine, findings suggestive of diffuse bone metastases.
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Figure 10c. Bone metastases in a 36-year-old woman who had undergone right modified radical mastectomy 1 year prior to US for a palpable lesion in the left breast. (a, b) Transverse (a) and sagittal (b) US images show an ill-defined irregular heterogeneous hypoechoic mass with a disrupted margin (arrows) in a rib. (c) Bone scintigram shows multiple areas of radionuclide uptake in the ribs and spine, findings suggestive of diffuse bone metastases.
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Conclusions
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Follow-up US in breast cancer patients after mastectomy has been very useful for detecting abnormalities at the mastectomy site. US has been reported to define the extent of recurrent breast carcinoma more clearly than physical examination or other imaging modalities, including mammography and CT. In addition, an accurate diagnosis may be made with US-guided fine needle aspiration biopsy.
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Abstract
LEARNING OBJECTIVES
