Mammographic Findings Associated with Accelerated Partial Breast Irradiation Using Single Fraction Intraoperative Radiotherapy

Kathleen C. Horst, Debra M. Ikeda, Katherine E. Fero, Jafi A. Lipson, Sunita Pal, Don R. Goffinet, Frederick M. Dirbas

Departments of Diagnostic Radiology, Stanford University, Stanford, USA.
Departments of Radiation Oncology, Stanford University, Stanford, USA.
Departments of Surgery, Stanford University, Stanford, USA..

DOI: 10.4236/jct.2012.325085                

Abstract

Purpose: To evaluate the mammographic findings of women treated with accelerated partial breast irradiation (APBI) using single-fraction intraoperative radiotherapy (IORT). Materials/Methods: Women ≥ 40 years of age with unifocal invasive or intraductal carcinoma ≤ 2.5 cm on physical examination, mammography, and ultrasound were enrolled on an APBI trial using single fraction IORT. Post-treatment mammographic imaging was obtained at 6 months, 1 year, and then annually. Results: Between 12/02 and 6/04, 17 women underwent IORT at the time of lumpectomy (median age = 60 years; range = 40 - 83). The initial post-IORT mammogram showed increased density at the lumpectomy site in 11 patients (65%), while six patients (35%) had architectural distortion in the area of the irradiated tissue. Fifteen patients (88%) had numerous punctate, benign-appearing calcifications corresponding to the irradiated region. There was focal skin thickening near the incision in 13 patients (76%). At a median of 67 months, architectural distortion had stabilized and the benign-appearing calcifications remained stable in number and character. Eight patients (47%) had mammographic findings consistent with fat necrosis, ranging in size from 0.5 - 4 cm. Conclusions: After lumpectomy and IORT, mammographic changes include increased density and benign appearing calcifications in the irradiated region with focal skin thickening. These changes appear to stabilize over time and are consistent with post-treatment changes. These changes are important to identify in order to characterize benign changes from recurrent tumor.

Keywords

Accelerated Partial Breast Irradiation (APBI); Intraoperative Radiotherapy (IORT); Breast Cancer;Mammography; Microcalcifications; Fat Necrosis

Conflicts of Interest

The authors declare no conflicts of interest.

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