Clinical manifestations and evaluation of locoregional recurrences of breast cancer

Authors:: Michael S Sabel, MD; Ariel Hirsch, MD; Jennifer R Bellon, MD
Section Editors:: Daniel F Hayes, MD; Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editors:: Wenliang Chen, MD, PhD; Sadhna R Vora, MD

Literature review current through: Jan 2024.

This topic last updated: Jan 10, 2023.

INTRODUCTION — Following breast-conserving therapy or mastectomy, breast cancer can recur locally, regionally, and/or at distant metastatic sites. A local recurrence is defined as reappearance of cancer in the ipsilateral preserved breast or chest wall. A regional recurrence denotes tumor involving the ipsilateral regional lymph nodes, usually the ipsilateral axillary or supraclavicular, and less commonly the infraclavicular and/or internal mammary. The term "locoregional recurrence" is used to indicate a recurrence in either the ipsilateral breast/chest wall or regional nodal basin, as opposed to a distant site.

In this topic, we discuss the epidemiology, risk factors, clinical manifestations, diagnosis, and evaluation of locoregionally recurrent breast cancer. Such cases typically require management in a multidisciplinary fashion, which is covered in other topics. (See "Surgery and radiation for locoregional recurrences of breast cancer" and "Systemic therapy for locoregionally recurrent breast cancer".)

Patients who have synchronous distant metastases with a locoregional recurrence are diagnosed as having stage IV breast cancer, the management of which is discussed elsewhere. (See "Overview of the approach to metastatic breast cancer".)

EPIDEMIOLOGY — The incidence of and time to local recurrence, and the pattern of recurrence, differ after breast-conserving therapy (BCT) versus mastectomy.

Local recurrence after breast-conserving therapy — The incidence of local recurrence after BCT in modern series is in the range of 2.5 to 5.5 percent [1-5]. (See "Breast-conserving therapy", section on 'Local recurrence'.)

Breast cancer recurs at a median of three to four years after BCT (five to seven years after adjuvant systemic therapy [6,7]), which is later than after mastectomy (median two to three years) [8-13]. This may be due to the differences in biology or presentation that led to a decision for mastectomy versus breast conservation.

Local recurrence after BCT may be either invasive or in situ cancer (ductal carcinoma in situ [DCIS]). For patients who were initially treated for invasive disease, more than 80 percent of locoregional recurrences are invasive; the remainder are DCIS. For patients initially treated for DCIS, approximately one-third will recur with invasive disease, whereas the remainder will have a recurrence of DCIS [14].

Approximately 75 percent of local recurrences after BCT are isolated to the breast and clinically solitary; 5 to 15 percent present with a simultaneous regional nodal recurrence, and another 5 to 15 percent have distant metastases at diagnosis [9,12,15-18].

Local recurrence after mastectomy — Approximately 2.3 to 3.6 percent of patients undergoing mastectomy for operable breast cancer will have a chest wall or regional nodal recurrence [19-24].

The median interval to a locoregional recurrence after mastectomy is two to three years, and 90 percent arise within five years [8,25-30]. Recurrence may be delayed in patients who receive adjuvant endocrine therapy [6,7,31,32].

There is wide variability in the reported incidence of simultaneous locoregional and distant metastases (10 to 60 percent) [6,26,33-37]. However, it is generally thought that approximately one-third of patients who present with a postmastectomy locoregional recurrence have synchronous distant disease [18,26].

In patients without distant disease, about half of the locoregional recurrences occur in the supraclavicular, axillary, or internal mammary nodes, with the supraclavicular nodes being the most common site, while the other half occur in the chest wall [38,39]. Sixty to 70 percent of the chest wall recurrences are isolated; 30 to 40 percent present with simultaneous chest wall and lymph node recurrences [26,40-43].

Regional recurrence — The incidence rate for regional recurrence in breast cancer, isolated or associated with local recurrence, ranges from 1 to 10 percent [44,45].

RISK FACTORS

In those treated with breast-conserving therapy — Ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) increases with omission of radiation therapy (RT) and a positive pathologic margin.

RT is considered a standard component of breast-conserving therapy (BCT) for the majority of women with invasive breast cancer or ductal carcinoma in situ (DCIS), the elimination of which is a major risk factor for both recurrence and, in select patients, mortality [46]. In a meta-analysis of 17 randomized trials involving 10,801 women undergoing BCS, RT to the conserved breast halved the recurrence rate [47]. However, certain subsets of women may be treated with lumpectomy alone, such as older women with estrogen receptor (ER)-positive disease.

For all patients undergoing BCS, tumor excision should be complete, such that negative margins are achieved. For invasive disease, the goal should be to ensure that there is no tumor at the inked border on microscopic pathologic examination; wider surgical margins are generally required for DCIS due to a greater propensity for multifocality. Positive or unknown histologic margins within breast tissue should prompt reexcision since such patients are at higher risk for local recurrence even when RT is administered. (See "Breast-conserving therapy", section on 'Margins of resection'.)

Other risk factors for local recurrence after BCT are [48-51]:

●Younger patient age

●Larger tumor size

●Higher tumor grade

●Presence of lymphovascular space invasion

●Absence of hormone receptors in the tumor (ie, ER- and progesterone receptor [PR]-negative breast cancer) [51-58]

In those treated with mastectomy — Risk for a postmastectomy local recurrence increases with the number of positive axillary lymph nodes and the size of the primary tumor [38].

Other factors that may help to predict for locoregionally recurrent disease after mastectomy include age at diagnosis, hormone receptor status, the presence of lymphovascular invasion or extracapsular nodal extension, and positive deep margins [48,59,60]. However, postmastectomy chest wall irradiation reduces the rate of chest wall recurrence by 65 to 75 percent.

CLINICAL MANIFESTATIONS

Ipsilateral breast tumor recurrence — Ipsilateral breast tumor recurrences (IBTRs) are generally detected either by finding a palpable mass on physical examination or as a change on post-treatment surveillance mammography.

Both radiation therapy (RT) and surgery can lead to changes in the breast, such as mass-like fibrosis, that can be difficult to distinguish from a local recurrence on physical examination. Furthermore, the findings associated with a local recurrence may be subtle, particularly if the primary tumor was an infiltrating lobular cancer. In such cases, a local recurrence may be associated with only minimal thickening or retraction of the biopsy site without a mass. Any change in the examination more than one or two years after completion of RT must be viewed as suspicious for recurrence and worked up. Since IBTRs detected on physical examination may be mammographically occult, a normal mammogram in the face of a change on physical examination does not rule out the possibility of a local recurrence.

Rarely, local recurrences after breast-conserving therapy (BCT) are inflammatory or extensively involve the skin [61-64]. Often, these are misdiagnosed as postoperative infection or breast lymphedema. Any patient with a history of breast cancer and new inflammatory-type changes in the breast (erythema, warmth, peau d'orange appearance) who does not respond readily to antibiotics should undergo a biopsy to rule out recurrent disease. In general, these patients have a poor prognosis.

Postmastectomy recurrence — A postmastectomy recurrence is usually detected clinically as a mass or multiple nodules in the chest wall or overlying skin in or near the mastectomy scar or in the skin flaps. The skin of the chest wall may also be diffusely involved with inflammatory changes without a discernible mass. The term "carcinoma en cuirasse" refers to a distinct form of local recurrence in which there is diffuse infiltration of the skin or subcutaneous tissues of the chest wall [65], with woody induration and spread of tumor often beyond the limits of standard surgical or radiation boundaries. Nodules and ulceration are often present.

Lymph node recurrence — Patients may also present with signs or symptoms of a regional recurrence: many patients present with palpable adenopathy in the axilla or supraclavicular fossa [66], although a regional recurrence may also present with pain in either location or the new onset of brachial plexopathy or lymphedema of the arm. These may occur in the absence of palpable adenopathy. Any patient who develops new-onset lymphedema following breast cancer treatment should be evaluated for the possibility of a regional recurrence.

Solitary "sternal metastases" may actually represent direct extension of involved internal mammary nodes. Such patients should be carefully imaged to adequately assess this distinction.

DIAGNOSTIC EVALUATION — The initial evaluation should include biopsy of all potential sites of disease (skin, chest wall, regional nodes) and staging to determine the extent of disease. Genetic testing should be considered for appropriate patients.

Breast/chest wall imaging — Any changes on physical examination should prompt imaging. (See "Approach to the patient following treatment for breast cancer", section on 'Breast imaging'.)

●For those who underwent previous breast-conserving therapy (BCT), a diagnostic mammogram and ultrasound of the lesion identified on examination are performed [67]. In cases where an abnormal finding was identified on screening mammography, a follow-up diagnostic mammogram should be performed, with ultrasound of any lesion that appears suspicious.

●For those who underwent previous mastectomy, ultrasound is usually the initial imaging study.

●Breast MRI may be performed when mammography and/or ultrasonography are inconclusive [67]. MRI is increasingly used to detect or evaluate suspected local recurrences. Although MRI may be more sensitive than mammography in detecting occult breast cancer recurrences [68-76], it is less specific, resulting in more false-positive imaging studies. (See "MRI of the breast and emerging technologies", section on 'Differentiating postoperative changes from recurrence'.)

In modern series of BCT, local recurrences are detected by mammography alone approximately 40 to 75 percent of the time, by physical examination alone in 10 to 30 percent, by a combination of mammography and physical examination in 10 to 25 percent, and by other imaging modalities (eg, magnetic resonance imaging [MRI]) in 5 percent of cases [77-81].

Axillary imaging — Given the substantial rate of simultaneous regional recurrences in patients with a locally recurrent breast cancer, axillary ultrasound of the regional nodal basins should be routinely performed, regardless of whether palpable adenopathy is appreciated on examination, and fine needle aspiration (FNA) or core biopsy can be used to confirm disease and deploy marker clips for future localization.

Biopsy — Any new clinical or radiographic finding that is suspicious for a recurrent malignancy should prompt a biopsy. FNA biopsy is a simple and accurate method for differentiating scar from recurrent carcinoma. However, tissue biopsy (core needle or excisional) may be needed not only to confirm the diagnosis of a local recurrence but also to assay the tumor tissue for hormone receptors and human epidermal growth factor receptor 2 (HER2) overexpression, as well as other factors such as phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutations in estrogen receptor (ER)-positive cancers and programmed cell death ligand 1 (PD-L1) in triple-negative cancers, each of which is important for treatment decisions regarding adjuvant chemotherapy and/or hormonal therapy and if the patient has distant metastases [82]. (See "Overview of the approach to metastatic breast cancer".)

The type of biopsy performed to diagnose a recurrence may also depend on the location of the recurrence. Internal mammary or supraclavicular recurrences are safer to sample via FNA, whereas other sites are amenable to core needle biopsy sampling. (See "Breast biopsy".)

The sites of resectable disease should be marked prior to initial therapy (regardless of whether initial surgical or systemic therapy is planned).

Evaluation for distant metastases — Patients who present with an invasive locoregional recurrent breast cancer may require complete restaging to rule out distant metastases [18]. For patients with simultaneous distant metastases, the treatment is systemic therapy, and the goal of treatment in this situation is palliation without intent to cure. (See "Overview of the approach to metastatic breast cancer".)

Some experts restage all patients with an invasive locoregional recurrence [83], while others only restage patients with a chest wall or regional recurrence but not always those with an in-breast recurrence after BCT.

If elected, restaging workup for metastatic diseases generally includes the following [84]:

●Radionuclide bone scan. Bone is the most common site of metastatic disease.

●Computed tomography (CT) of the chest, abdomen, and pelvis [85,86]. The most common site of unsuspected disease is in the internal mammary lymph nodes. Chest CT is also useful to differentiate recurrent tumor in the chest wall, subcutaneous fat, pectoralis muscles, and brachial plexus from postoperative and postradiation change [85,86]. MRI of the chest and abdominal imaging is a satisfactory alternative, especially of the thorax if patients cannot tolerate CT contrast dye.

●For patients with symptoms of a brachial plexopathy or arm edema without obvious adenopathy, contrast-enhanced MRI can help in the distinction between tumor recurrence versus radiation-induced fibrosis [87]. (See "Brachial plexus syndromes", section on 'Neoplastic and radiation-induced brachial plexopathy'.)

●Increasingly, positron emission tomography/CT (PET/CT) is being used in lieu of bone scintigraphy and dedicated CT scanning to survey the entire body for sites of distant metastatic spread (but not brain involvement) in patients with a documented locoregional recurrence [88-93]. PET scans are more sensitive than conventional imaging such as CT, and the detection of unsuspected metastatic disease may alter the therapeutic plan. However, PET scans are limited by a high false-positive rate (approximately 11 percent in a pooled analysis [94]), which may lead to additional imaging studies and biopsies, and further, they are usually done with limited CT scanning, as opposed to a dedicated CT.

Genetic counseling — Genetic counseling and genetic testing may also be important, depending on age, personal and family history, and the biologic subtype of the cancer. The clinician should obtain an updated family history and consider genetic testing or retesting if testing was not done recently, given the more informative multigene panels available today. (See "Genetic testing and management of individuals at risk of hereditary breast and ovarian cancer syndromes".)

DIAGNOSIS — Diagnosis is confirmed by histologic features of a biopsy specimen. (See 'Biopsy' above and "Pathology of breast cancer".)

DIFFERENTIAL DIAGNOSIS

Benign and other malignant etiologies — Differential diagnosis of a breast or chest wall lump identified radiographically or on examination in a patient previously treated for breast cancer includes a new primary breast cancer rather than a recurrence; fat necrosis, which may occur after any previous surgery to the breast; radiation fibrosis; other types of malignancies (eg, breast sarcoma, which can arise after radiation); infection; and benign breast lesions. (See "Clinical manifestations, differential diagnosis, and clinical evaluation of a palpable breast mass".)

In general, these etiologies are distinguished from a recurrent breast cancer on the basis of pathologic findings on the biopsy specimen. However, a true recurrence can be more difficult to differentiate from a new primary, as discussed below.

Distinguishing a new primary from a recurrence — The reappearance of disease in an ipsilateral preserved breast after breast-conserving therapy (BCT) can represent either a local recurrence of the initial cancer or a second primary tumor.

Whereas a chest wall recurrence after mastectomy is usually reflective of true recurrent disease, rarely, it may be an entirely new primary because the breast is not an encapsulated organ, and therefore mastectomy may not remove all potentially at-risk normal ductal and lobular units, which may then generate a new malignancy at a later date.

A recurrence of the original tumor can be distinguished from a new primary by its location relative to the original tumor. After BCT, 50 to 90 percent of ipsilateral breast tumor recurrences (IBTRs) occur in the same quadrant as the original tumor, representing a true recurrence (within the primary tumor site or boost volume of the treated breast) or marginal miss (near but not within the boost volume). As the interval from initial diagnosis lengthens, malignancies are more likely to arise in other quadrants of the breast, likely representing mainly new primary tumors [16,95-97].

The distinction can also be made on other grounds (eg, histologic subtype, mammographic appearance, hormone receptor status, human epidermal growth factor receptor 2 [HER2] overexpression, discordant DNA [deoxyribonucleic acid] flow cytometry) [11,97-100]. Typically, the estrogen receptor (ER)/progesterone receptor (PR) and HER2 receptor status of a true recurrence, but not necessarily a new primary, should be the same as in the original primary tumor. At least some data suggest that molecular classification is a more reliable method for distinguishing a true (ie, genetically related) recurrence versus a genetically distinct second primary tumor [101,102].

Ipsilateral new primary breast cancers tend to develop later in the follow-up period than do true local recurrences (eg, median of 7.3 versus 3.7 years in one study [98]), and the prognosis is generally more favorable. Although ipsilateral second primary tumors are not generally treated differently from true recurrences at present, some studies suggest the potential for tailoring therapy based upon molecular classification, which may have therapeutic and prognostic implications. (See "Surgery and radiation for locoregional recurrences of breast cancer", section on 'New primary versus true recurrence' and "Systemic therapy for locoregionally recurrent breast cancer".)

TREATMENT AND PROGNOSIS — Locoregional recurrent breast cancers require multimodal treatments including surgery, radiation therapy, and, frequently, systemic therapy. The treatment strategies and prognosis are discussed in separate topics. (See "Surgery and radiation for locoregional recurrences of breast cancer" and "Systemic therapy for locoregionally recurrent breast cancer".)

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Breast cancer" and "Society guideline links: Breast surgery".)

SUMMARY AND RECOMMENDATIONS

●Locoregional recurrence rate – The incidence of locoregional recurrence of breast cancer is 2.5 to 5.5 percent after breast-conserving therapy (BCT) and 2.2 to 3.6 percent after mastectomy. The median interval to recurrence is longer after BCT (three to four years) than after mastectomy (two to three years). (See 'Epidemiology' above.)

●Risk factors – The major risk factors for locoregional recurrences after BCT are lack of radiation therapy and positive pathologic margins. The locoregional recurrences after mastectomy are best predicted by the size of the primary and the number of positive lymph nodes. (See 'Risk factors' above.)

●Clinical manifestations

•Ipsilateral breast tumor recurrences after BCT are generally detected either by finding a palpable mass on physical examination or as a change on post-treatment surveillance mammography. (See 'Ipsilateral breast tumor recurrence' above.)

•A postmastectomy recurrence is usually detected clinically as a mass or multiple nodules in the chest wall or overlying skin in or near the mastectomy scar or in the skin flaps. (See 'Postmastectomy recurrence' above.)

•Lymph node recurrences are usually detected as palpable adenopathy in the axilla or supraclavicular fossa, although a regional recurrence may also present with pain in either location or the new onset of brachial plexopathy or lymphedema of the arm. (See 'Lymph node recurrence' above.)

●Diagnostic evaluation – The initial evaluation of suspected recurrent breast cancer should include biopsy of potential sites of disease (skin, chest wall, regional nodes) and breast/chest wall, axilla, and body imaging to determine the extent of recurrence and to exclude metastatic disease. Genetic testing may also be offered to appropriate patients. (See 'Diagnostic evaluation' above.)

Some experts restage all patients with an invasive locoregional recurrence, while others only restage patients with a chest wall or regional recurrence but not always those with an in-breast recurrence after BCT. (See 'Evaluation for distant metastases' above.)

●Differential diagnosis – The differential diagnosis of a breast or chest wall lump identified radiographically or on examination in a patient previously treated for breast cancer includes a new primary breast cancer; a recurrence; fat necrosis, which may occur after any previous surgery to the breast; radiation fibrosis; other types of malignancies (eg, breast sarcoma, which can arise after radiation); infection; and benign breast lesions. (See 'Differential diagnosis' above.)

●Distinguishing a true recurrence from a new primary tumor – A recurrence of the original tumor may be putatively distinguished from a new primary by its location relative to the original tumor or on other grounds (eg, histologic subtype, mammographic appearance, hormone receptor status, human epidermal growth factor receptor 2 [HER2] overexpression, discordant DNA flow cytometry). Distinguishing a true recurrence from a new primary by molecular classification may have therapeutic and prognostic implications. (See 'Distinguishing a new primary from a recurrence' above.)

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Cheng SH, Horng CF, Clarke JL, et al. Prognostic index score and clinical prediction model of local regional recurrence after mastectomy in breast cancer patients. Int J Radiat Oncol Biol Phys 2006; 64:1401.
Nomura M, Inoue Y, Fujita S, et al. Pathological complete response to trastuzumab and paclitaxel in a patient with inflammatory local recurrence following breast conserving surgery. Breast Cancer 2005; 12:226.
Kurtz JM, Jacquemier J, Brandone H, et al. Inoperable recurrence after breast-conserving surgical treatment and radiotherapy. Surg Gynecol Obstet 1991; 172:357.
Gage I, Schnitt SJ, Recht A, et al. Skin recurrences after breast-conserving therapy for early-stage breast cancer. J Clin Oncol 1998; 16:480.
Huston TL, Simmons RM. Inflammatory local recurrence after breast-conservation therapy for noninflammatory breast cancer. Am J Clin Oncol 2005; 28:431.
Sharma V, Kumar A. Carcinoma en Cuirasse. N Engl J Med 2021; 385:2562.
Kuo SH, Huang CS, Kuo WH, et al. Comprehensive locoregional treatment and systemic therapy for postmastectomy isolated locoregional recurrence. Int J Radiat Oncol Biol Phys 2008; 72:1456.
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Mumtaz H, Davidson T, Hall-Craggs MA, et al. Comparison of magnetic resonance imaging and conventional triple assessment in locally recurrent breast cancer. Br J Surg 1997; 84:1147.
Dao TH, Rahmouni A, Campana F, et al. Tumor recurrence versus fibrosis in the irradiated breast: differentiation with dynamic gadolinium-enhanced MR imaging. Radiology 1993; 187:751.
Belli P, Costantini M, Romani M, et al. Magnetic resonance imaging in breast cancer recurrence. Breast Cancer Res Treat 2002; 73:223.
Rieber A, Schramm K, Helms G, et al. Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease. Eur Radiol 2003; 13:780.
Krämer S, Schulz-Wendtland R, Hagedorn K, et al. Magnetic resonance imaging in the diagnosis of local recurrences in breast cancer. Anticancer Res 1998; 18:2159.
Muüller RD, Barkhausen J, Sauerwein W, Langer R. Assessment of local recurrence after breast-conserving therapy with MRI. J Comput Assist Tomogr 1998; 22:408.
Teifke A, Lehr HA, Vomweg TW, et al. Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol 2003; 181:655.
Drew PJ, Kerin MJ, Turnbull LW, et al. Routine screening for local recurrence following breast-conserving therapy for cancer with dynamic contrast-enhanced magnetic resonance imaging of the breast. Ann Surg Oncol 1998; 5:265.
Heywang-Köbrunner SH, Schlegel A, Beck R, et al. Contrast-enhanced MRI of the breast after limited surgery and radiation therapy. J Comput Assist Tomogr 1993; 17:891.
Dershaw DD, McCormick B, Osborne MP. Detection of local recurrence after conservative therapy for breast carcinoma. Cancer 1992; 70:493.
Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer 2001; 91:1090.
Weng EY, Juillard GJ, Parker RG, et al. Outcomes and factors impacting local recurrence of ductal carcinoma in situ. Cancer 2000; 88:1643.
Montgomery DA, Krupa K, Jack WJ, et al. Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience. Br J Cancer 2007; 96:1802.
Montgomery DA, Krupa K, Cooke TG. Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature. Br J Cancer 2007; 97:1632.
Aebi S, Gelber S, Anderson SJ, et al. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol 2014; 15:156.
Elfgen C, Schmid SM, Tausch CJ, et al. Radiological Staging for Distant Metastases in Breast Cancer Patients with Confirmed Local and/or Locoregional Recurrence: How Useful are Current Guideline Recommendations? Ann Surg Oncol 2019; 26:3455.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Breast cancer. Version 3.2020 - March 6, 2020. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (Accessed on May 05, 2020).
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Lingawi SS, Bilbey JH, Munk PL, et al. MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence. Skeletal Radiol 1999; 28:318.
Radan L, Ben-Haim S, Bar-Shalom R, et al. The role of FDG-PET/CT in suspected recurrence of breast cancer. Cancer 2006; 107:2545.
Eubank WB, Mankoff D, Bhattacharya M, et al. Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer. AJR Am J Roentgenol 2004; 183:479.
Gallowitsch HJ, Kresnik E, Gasser J, et al. F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol 2003; 38:250.
Eubank WB, Mankoff DA, Takasugi J, et al. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 2001; 19:3516.
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Constantinidou A, Martin A, Sharma B, Johnston SR. Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital. Ann Oncol 2011; 22:307.
Isasi CR, Moadel RM, Blaufox MD. A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Res Treat 2005; 90:105.
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Topic 128420 Version 7.0

References

1 : Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients.

2 : Prediction of Local Recurrence After Oncoplastic Breast Surgery: Analysis of a Large Cohort.

3 : Oncoplastic Repair in Breast Conservation: Comprehensive Evaluation of Techniques and Oncologic Outcomes of 937 Patients.

4 : Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review.

5 : A systematic review of oncoplastic volume replacement breast surgery: oncological safety and cosmetic outcome.

6 : Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer. Impact of clinical, histopathologic, and flow cytometric factors.

7 : Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients.

8 : Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial.

9 : Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer.

10 : Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group.

11 : Local recurrence versus new primary: clinical analysis of 82 breast relapses and potential applications for genetic fingerprinting.

12 : Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer.

13 : Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer.

14 : Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17.

15 : Prognostic significance of breast relapse after conservative treatment in node-negative early breast cancer.

16 : Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment.

17 : Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer.

18 : Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and III Breast Cancer (AFT-01).

19 : Can a subgroup at high risk for LRR be identified from T1-2 breast cancer with negative lymph nodes after mastectomy? A meta-analysis.

20 : Rates of Ipsilateral Local-regional Recurrence in High-risk Patients Undergoing Immediate Post-mastectomy Reconstruction (AFT-01).

21 : No increase of local recurrence rate in breast cancer patients treated with skin-sparing mastectomy followed by immediate breast reconstruction.

22 : Oncologic Safety of Immediate Breast Reconstruction for Invasive Breast Cancer Patients: A Matched Case Control Study.

23 : Long-term Oncologic Outcomes of Immediate Breast Reconstruction vs Conventional Mastectomy Alone for Breast Cancer in the Setting of Neoadjuvant Chemotherapy.

24 : Oncologic Outcomes After Nipple-Sparing Mastectomy.

25 : Local-regional failure in patients treated with adjuvant chemotherapy for breast cancer.

26 : Locoregional recurrence after mastectomy: incidence and outcomes.

27 : Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis.

28 : Local-regional control of recurrent breast carcinoma after mastectomy: does hyperfractionated accelerated radiotherapy improve local control?

29 : Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy.

30 : The results of radiation therapy for isolated local regional recurrence after mastectomy.

31 : 20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years.

32 : Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials.

33 : Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer.

34 : Role of isolated locoregional recurrence of breast cancer: results of four prospective studies.

35 : Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial.

36 : Local recurrence after mastectomy or breast-conserving surgery and radiation.

37 : Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group.

38 : Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation.

39 : Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies.

40 : The implications of local recurrence of breast cancer as the first site of therapeutic failure.

41 : Locoregional recurrences after 649 modified radical mastectomies: incidence and significance.

42 : Isolated locoregional recurrence patterns of breast cancer after mastectomy and adjuvant systemic therapies in the contemporary era.

43 : The Effect of Molecular Subtype and Residual Disease on Locoregional Recurrence in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy and Postmastectomy Radiation.

44 : Loco-regional recurrence and survival after wide local excision, radiotherapy and axillary clearance for early breast cancer.

45 : Breast cancer: risk of axillary recurrence in node-negative patients following partial dissection of the axilla.

46 : Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.

47 : Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials.

48 : Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials.

49 : Analysis of local and regional recurrences in breast cancer after conservative surgery.

50 : Subsets of women with close or positive margins after breast-conserving surgery with high local recurrence risk despite breast plus boost radiotherapy.

51 : Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies.

52 : Efficacy of Chemotherapy for ER-Negative and ER-Positive Isolated Locoregional Recurrence of Breast Cancer: Final Analysis of the CALOR Trial.

53 : Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype.

54 : Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer.

55 : 21-Gene recurrence score and locoregional recurrence in lymph node-negative, estrogen receptor-positive breast cancer.

56 : 21-Gene Recurrence Score and Locoregional Recurrence in Node-Positive/ER-Positive Breast Cancer Treated With Chemo-Endocrine Therapy.

57 : Basal subtype of invasive breast cancer is associated with a higher risk of true recurrence after conventional breast-conserving therapy.

58 : High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller.

59 : Loco-regional recurrence after mastectomy in high-risk breast cancer--risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials.

60 : Prognostic index score and clinical prediction model of local regional recurrence after mastectomy in breast cancer patients.

61 : Pathological complete response to trastuzumab and paclitaxel in a patient with inflammatory local recurrence following breast conserving surgery.

62 : Inoperable recurrence after breast-conserving surgical treatment and radiotherapy.

63 : Skin recurrences after breast-conserving therapy for early-stage breast cancer.

64 : Inflammatory local recurrence after breast-conservation therapy for noninflammatory breast cancer.

65 : Carcinoma en Cuirasse.

66 : Comprehensive locoregional treatment and systemic therapy for postmastectomy isolated locoregional recurrence.

67 : ACR Appropriateness Criteria®Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women.

68 : Comparison of magnetic resonance imaging and conventional triple assessment in locally recurrent breast cancer.

69 : Tumor recurrence versus fibrosis in the irradiated breast: differentiation with dynamic gadolinium-enhanced MR imaging.

70 : Magnetic resonance imaging in breast cancer recurrence.

71 : Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease.

72 : Magnetic resonance imaging in the diagnosis of local recurrences in breast cancer.

73 : Assessment of local recurrence after breast-conserving therapy with MRI.

74 : Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast.

75 : Routine screening for local recurrence following breast-conserving therapy for cancer with dynamic contrast-enhanced magnetic resonance imaging of the breast.

76 : Contrast-enhanced MRI of the breast after limited surgery and radiation therapy.

77 : Detection of local recurrence after conservative therapy for breast carcinoma.

78 : Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast.

79 : Outcomes and factors impacting local recurrence of ductal carcinoma in situ.

80 : Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience.

81 : Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature.

82 : Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial.

83 : Radiological Staging for Distant Metastases in Breast Cancer Patients with Confirmed Local and/or Locoregional Recurrence: How Useful are Current Guideline Recommendations?

84 : Radiological Staging for Distant Metastases in Breast Cancer Patients with Confirmed Local and/or Locoregional Recurrence: How Useful are Current Guideline Recommendations?

85 : CT evaluation of local and regional breast cancer recurrence.

86 : The role of computed tomography in the evaluation of post-mastectomy locally recurrent breast cancer.

87 : MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence.

88 : The role of FDG-PET/CT in suspected recurrence of breast cancer.

89 : Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer.

90 : F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging.

91 : 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer.

92 : Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma.

93 : Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital.

94 : A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases.

95 : Local recurrence in the breast after conservative surgery--a study of prognosis and prognostic factors in 391 women.

96 : Ipsilateral breast tumor recurrence after breast conservation therapy: outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation.

97 : Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences.

98 : True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management.

99 : Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events.

100 : Classification of ipsilateral breast tumor recurrences after breast conservation therapy can predict patient prognosis and facilitate treatment planning.

101 : The use of molecular assays to establish definitively the clonality of ipsilateral breast tumor recurrences and patterns of in-breast failure in patients with early-stage breast cancer treated with breast-conserving therapy.

102 : High-resolution mapping of DNA breakpoints to define true recurrences among ipsilateral breast cancers.

خرید پکیج

Clinical manifestations and evaluation of locoregional recurrences of breast cancer

References