2.15 Imaging the Axilla
2.16 Post-Operative Mammography
2.15 Imaging the Axilla – regarding Lymph Nodes
For patients who have a suspicious BI-RADS 4c or 5 lesion on mammography, it is recommended that ultrasound scanning of the ipsilateral axilla should be performed to evaluate any suspicious or abnormal axillary lymph nodes.
Percutaneous fine needle aspiration (FNA) of a lymph node deemed to be suspicious is an appropriate intervention.
If the FNA cytology shows that malignant cells are present in the axillary lymph node, the patient should be evaluated to determine if an axillary lymph node dissection is necessary. The lymph node dissection will be done at the time of the surgical management of the primary breast cancer.
2.16 Post-Operative Mammography
Post-operative mammograms are advised to look for any residual micro-calcifications after surgical resection has been done. This is advised when the micro-calcifications are either not completely documented on the specimen radiograph or else when excision margins are very close or are positive (Gluck et al., 1993).
A re-excision on the basis of residual calcifications should only be recommended if the breast calcifications are associated with malignancy on histopathology.
Post-operative mammography is performed between three to five weeks following excision of a breast cancer and is meant to complement specimen mammography and histologic margin assessment.
In 1998, the American College of Radiology, the American College of Surgeons, the College of American Pathologists and the Society of Surgical Oncology published their guidelines for management of Ductal Carcinoma in Situ (DCIS), especially in the setting of calcifications (Winchester & Strom, 1998).
Residual suspicious breast calcification may be identified in up to 24 % of patients, most of which represent residual DCIS. It is recommended that these suspicious breast calcifications should be removed. The consensus view is that it is better to identify residual breast calcifications prior to any radiation therapy as identification of residual disease may be interpreted as a new disease and may, therefore, prompt a mastectomy.
Gluck, B.S., Dershaw, D.C., Liberman, L., Deutch, B.M.(1993). Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision. Radiology. 188(2), 469. (Retrieved October 29th 2014): http://pubs.rsna.org/doi/abs/10.1148/radiology.188.2.8327699?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
Winchester, D.P., Strom, E.A. (1998). Standards for diagnosis and management of ductal carcinoma in situ (DCIS) of the breast. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin 48(2),108. (Retrieved October, 29th 2014): http://www.ncbi.nlm.nih.gov/pubmed?term=9522825
ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37 (2-4), 2007http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103
NCCN Guidelines for Patients with Stage 0 Breast Cancer. (Retrieved October 29th 2014): http://www.nccn.org/patients/guidelines/stage_0_breast/index.html