Thanks! I remember that thread and was looking for it but couldn't recall the title nor where it was.
YW.
As I was chugging along my reading of NMS Case Book, it mentioned going straight to core needle or excisional bx for a recurrent mass s/p MRMwith subsequent staging,
For a mastectomy patient (and remember, not all mastectomies are MRM), it IS appropriate to go straight to biopsy as mammograms are not indicated. Most of these recurrences are going to be found by clinical breast exam and will be in the skin or along the scar, so imaging isn't really going to help you in terms of biopsy.
If the patient has implant reconstruction, I sometimes prefer imaging with US prior to biopsy as examination in relationship to closeness to the implant can be deceiving. But I have my own US in office, so its a bit of a different situation in which the average surgeon does not.
I got questioned about that on my oral boards as they quizzically looked at me when I mentioned using US for a palpable mass. My defense (which apparently worked) was that:
a) documents exactly where I am in the breast and mass
b) documents that the biopsy was actually done
c) documents procedure for US certification
d) shows placement of titanium clip
As we discussed in the other thread, what is done in clinical practice is not what is necessarily on the exam. For example, in almost no cases is it appropriate to do an excisional biopsy when a needle biopsy can be done. However, it is the "Safe Answer" so you cannot be faulted for choosing excisional biopsy unless needle is another option.
...but I misread what it said for a recurrent mass s/p lumpectomy. I guess that's how I got that "even if" clause in there.
As far as biannual mammo's after lumpectomy, I got that from the NMS Case Book as well. Additionally, according to the American Cancer Society, they say that some "experts" prefer mammo's every 6 months for 2-3 years, although I couldn't find any guidelines for imaging after breast conservation surgery.
That is because they don't really exist in any formal fashion. It is true that "some" prefer q6 mo imaging x 2 years and then yearly after, and it is true that "some" prefer clinical follow up q6 mo. These are probably the safe answers but the ACS doesn't always reflect data or what everyone does. I'd say for purposes of the exam, if that's what NMS says to do, you won't be faulted, as its better to be more conservative than miss something, but there's no evidence that these frequent mammograms in post-operative patients make a difference. The typical recurrence, especially early in patients on hormonal blockade or after chemo, is palpable.
What's your practice for follow-up mammo's?
See above post. Depends on the patient, but two in the first year and then yearly after that. Usually the med oncs are getting PETs anyway and sometimes MRIs on the chemo patients and/or young patients so I don't find the additional MMG adds anything.
