MRI also helpful: mammography helps distinguish surgical sequelae from breast cancer recurrence.(Gynecology)

MIAMI BEACH -- Mammography can be used after breast cancer surgery to distinguish surgical sequelae from recurrence of cancer, according to a presentation at the annual meeting of the American Roentgen Ray Society.

Comparison of follow-up mammography with a preoperative image can go a long way in differentiating normal surgical effects, such as calcifications, edema, and scarring, from cancer recurrence, said Dr. D. David Dershaw, who is the director of breast imaging at Memorial Sloan-Kettering Cancer Center, New York.

Mammography is best for detecting cancers containing microcalcifications. Women with calcium in their tumor should have mammography about 2-4 weeks post excision to ensure the cancer was completely removed, Dr. Dershaw suggested.

The positive predictive value of residual calcifications is 85%, and the negative predictive value of complete removal of calcium is 66%, Dr. Dershaw reported at the meeting.

"If all the calcium is out, it doesn't mean all the tumor is out. There can be tumor that is not calcified. On the other hand, there can be calcification without cancer, but the likelihood of cancer is high [with calcification]."

"The only time you need to remove these is if they look on the acute postop mammogram like the preoperative calcification associated with the cancer. If the patient had all of the calcium taken out and she comes back post therapy with calcification, I do nothing," he said.

An estimated 20%-25% of patients develop these coarse, benign calcifications years after therapy.