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Recurrent Cancer After Breast-Conserving Surgery with Radiation Therapy for Ductal Carcinoma in Situ: Mammographic Features, Method of Detection, and Stage of Recurrence

Renee W. Pinsky1, Murray Rebner2, Lori J. Pierce3, Merav A. Ben-David3,4, Frank Vicini5, Karen A. Hunt1,6 and Mark A. Helvie1

1 Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0302.
2 Department of Radiology, William Beaumont Hospital, Royal Oak, MI.
3 Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI.
4 Present address: Oncology Department, Radiation Oncology Unit, Sheba Medical Center, Ramat-Gan, Israel.
5 Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI.
6 Present address: Department of Radiology, Henry Ford Hospital, West Bloomfield, MI.


Figure 1
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  		Fig. 1A —43-year-old woman developed pleomorphic microcalcifications on follow-up mammography 7 years after breast-conserving surgery and radiation therapy for ductal carcinoma in situ (DCIS). Her recurrence was invasive lobular carcinoma, with lobular carcinoma in situ located 9 cm from original lumpectomy site in same quadrant. Mediolateral oblique mammogram at time of recurrence. Surgical clips indicate lumpectomy bed. Circle indicates site of recurrence.

 

Figure 2
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  		Fig. 1B —43-year-old woman developed pleomorphic microcalcifications on follow-up mammography 7 years after breast-conserving surgery and radiation therapy for ductal carcinoma in situ (DCIS). Her recurrence was invasive lobular carcinoma, with lobular carcinoma in situ located 9 cm from original lumpectomy site in same quadrant. Spot magnification view of primary DCIS at time of wire localization shows microcalcifications.

 

Figure 3
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  		Fig. 1C —43-year-old woman developed pleomorphic microcalcifications on follow-up mammography 7 years after breast-conserving surgery and radiation therapy for ductal carcinoma in situ (DCIS). Her recurrence was invasive lobular carcinoma, with lobular carcinoma in situ located 9 cm from original lumpectomy site in same quadrant. Spot magnification view of recurrence also shows microcalcifications.

 

Figure 4
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  		Fig. 2 —50-year-old woman with recurrence presenting as microcalcifications 3 years after treatment. Magnification of mediolateral oblique view of lumpectomy site shows clips and scar. Note new pleomorphic microcalcifications nearby. These microcalcifications were ductal carcinoma in situ with microinvasion located 2 cm from lumpectomy site.

 

Figure 5
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  		Fig. 3 —Time interval (in years) from initial diagnosis of ductal carcinoma in situ to recurrence versus percentage of total patients.

 

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