Imagerie du sein opéré et traité

Abstract

Breast imaging plays a major role during and after treatment of a breast cancer. Immediate postoperative mammography is required to confirm the complete excision of cancers that contained calcifications. Ultrasound is the best examination for the detection of immediate postsurgical complications such as hematoma, abcess or lymphocele. Post-therapeutic benign changes (surgery, radiotherapy) have to be known for avoiding unusefull invasive explorations. Breast scars, irradiated breast and fat necrosis will be described over time at mammography, ultrasound and MRI. Local treatment failure that occurs within the first 5 to 7 years after treatment is most likely to be located at or near the site of original cancer ; in approximatively 50 % of cases, the local relapse will be detected by suspicious microcalcifications on mammmograms. Local failure after ten years is commonly caused by carcinomas growing elsewhere in the breast. Ultrasound is useful for analyzing architectural distorsion, focal asymmetric breast tissue, post-therapeutic dense breasts or abnormal clinical findings. Magnetic resonance imaging has a high specificity and negative predictive value in this population allowing the elimination of an infiltrating relapse in difficult cases. In these treated patients, quality control of mammograms and comparison with previous imaging data are mandatory at each annual imaging follow-up.