Background: Breast cancer requires long-term surveillance, as recurrence and mortality risks extend beyond 10 years. Mammography (MMG) is the standard imaging modality; however, its effectiveness is reduced in Asian women owing to dense breast tissue. The optimal timing of surveillance MMG after breast-conserving surgery remains unclear, particularly the value of routine 6-month MMG. We evaluated the roles of MMG and ultrasound in detecting ipsilateral and contralateral breast cancer recurrence after breast-conserving surgery. Methods: This retrospective study included 961 patients with operable breast cancer who underwent breast-conserving surgery with or without axillary surgery between 2011 and 2015 at Kyungpook National University Chilgok Hospital. Surveillance consisted of biannual imaging for the first 2 years, followed by annual imaging for up to 10 years. Ipsilateral and contralateral breast cancer recurrences were analyzed according to detection modality, including MMG and ultrasound. Multivariate Cox proportional hazards regression analysis was performed to identify independent risk factors for recurrence. Results: During a mean follow-up of 139 months, 56 patients (5.8%) experienced locoregional recurrence, and 41 (4.3%) developed distant metastasis. Among 35 in-breast recurrences, 14 (40.0%) were ipsilateral and 21 (60.0%) contralateral. Ipsilateral recurrences were more often detected via either MMG or ultrasound alone, whereas contralateral cancers were typically detected through both modalities. During the first postoperative year, all ipsilateral and contralateral recurrences were detected exclusively by ultrasound, with no cancers identified by 6-month MMG (95% CI for 6-month detection: 0–0.38%). Multivariate analysis identified positive axillary lymph node status as the only independent predictor of locoregional recurrence (HR 2.52, 95% CI 1.14–5.54,p= 0.022). Detection patterns showed no significant differences across molecular subtypes (p= 0.665). Conclusions: Annual MMG remains appropriate for breast cancer surveillance in accordance with current guidelines. However, MMG at 6 months post-surgery may be unnecessary, as early detection during the first year was achieved solely by ultrasound. The complementary role of MMG and ultrasound is consistent regardless of molecular subtype.
背景：乳腺癌需要长期监测，因为复发和死亡风险可能持续超过10年。乳腺X线摄影（MMG）是标准影像学检查方法，但由于亚洲女性乳腺组织致密，其检测效果有所降低。保乳手术后监测性MMG的最佳时机尚不明确，尤其是常规6个月MMG的价值。本研究评估了MMG和超声在检测保乳术后同侧及对侧乳腺癌复发中的作用。 方法：这项回顾性研究纳入了2011年至2015年间在庆北国立大学漆谷医院接受保乳手术（伴或不伴腋窝手术）的961例可手术乳腺癌患者。监测方案为术后前2年每半年进行影像学检查，之后每年检查一次，持续至10年。根据检测方式（包括MMG和超声）分析同侧及对侧乳腺癌复发情况。采用多变量Cox比例风险回归分析确定复发的独立危险因素。 结果：在平均139个月的随访期间，56例患者（5.8%）出现局部区域复发，41例（4.3%）发生远处转移。在35例乳腺内复发中，14例（40.0%）为同侧复发，21例（60.0%）为对侧复发。同侧复发更多通过单一影像学方式（MMG或超声）检出，而对侧癌变通常需两种方式联合检测。术后第一年内，所有同侧及对侧复发均仅通过超声检出，6个月MMG未发现任何癌变（6个月检出率的95% CI：0–0.38%）。多变量分析显示，腋窝淋巴结阳性是局部区域复发的唯一独立预测因子（HR 2.52，95% CI 1.14–5.54，p=0.022）。不同分子亚型间的检测模式无显著差异（p=0.665）。 结论：根据现行指南，年度MMG仍是乳腺癌监测的适宜方法。然而，术后6个月的MMG可能并无必要，因为第一年内的早期检测完全依靠超声实现。无论分子亚型如何，MMG与超声的互补作用保持一致。
肿瘤(癌症)患者之家